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UBC Theses and Dissertations

An evaluation of the role, theory, and practice of the occupation of homemaker Auman, Jane Tate 1981

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AN EVALUATION OF THE ROLE, THEORY, AND PRACTICE OF THE OCCUPATION OF HOMEMAKER by JANE[TATE AUMAN B.A., The U n i v e r s i t y  of B r i t i s h Columbia,  1974  A THESIS SUBMITTED I N PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in .THE FACULTY OF GRADUATE STUDIES Department of C u r r i c u l u m and I n s t r u c t i o n a l  We a c c e p t t h i s t h e s i s a s c o n f o r m i n g to the r e q u i r e d  standard  THE UNIVERSITY OF B R I T I S H COLUMBIA O c t o b e r , 1981  (5) J a n e T a t e Auman, 1981  Studies  In p r e s e n t i n g  this thesis  in partial  r e q u i r e m e n t s f o r an a d v a n c e d  degree  of  B r i t i s h Columbia, I agree that  it  freely available  the Library  copying or p u b l i c a t i o n  f i n a n c i a l gain  shall  Department o f The U n i v e r s i t y o f B r i t i s h 2075 W e s b r o o k P l a c e V a n c o u v e r , Canada V6T 1W5  (7/7Q)  further thesis  of t h i s  Itis thesis  n o t be a l l o w e d w i t h o u t my  permission.  DK-fi  I  make  be g r a n t e d by t h e h e a d o f my  o r by h i s o r h e r r e p r e s e n t a t i v e s .  understood that  shall  f o r extensive copying of t h i s  f o r s c h o l a r l y p u r p o s e s may  for  a t the U n i v e r s i t y  f o r r e f e r e n c e and study.  agree t h a t p e r m i s s i o n department  f u l f i l m e n t of the  h—'  Columbia  written  ABSTRACT  A homemaker i s an i n d i v i d u a l  who i s e m p l o y e d by a  homemaking a g e n c y f o r t h e p u r p o s e o f p r o v i d i n g in-home s e r v i c e to  specific  clients.  These c l i e n t  and/or p e r s o n a l care a s s i s t a n c e .  s e r v i c e s i n v o l v e housekeeping Until  now l i t t l e  r e s e a r c h has  been done i n t h e a r e a o f homemaking a s an o c c u p a t i o n . Therefore, for  present  areas data  study  i s intended  to provide research  and f u t u r e work c o n c e r n i n g  of t h e i r  from s u p e r v i s o r case  i n the years  background  t h e homemakers i n t h e  r o l e c h a n g e , t h e o r y , and p r a c t i c e .  base o b t a i n e d  clients at  this  notes  Using the  o f homemaker  1976 a n d 1980, t h i s s t u d y a t t e m p t e d  t h e r o l e changes t h a t o c c u r r e d and t h e d i s c r e p a n c y  to look  that  e x i s t e d b e t w e e n t h e p r a c t i c e o f homemakers i n an a g e n c y a n d t h e practice The each from  i t s homemakers were t a u g h t  w i t h i n the classroom.  s a m p l e d a t a was d e r i v e d f r o m one h u n d r e d c l i e n t 1976 a n d f r o m  1980.  The i n d i v i d u a l  randomly s e l e c t e d from t h e f i l e s  files  files  were  of a l a r g e m e t r o p o l i t a n  homemaker a g e n c y w i t h i n t h e p r o v i n c e o f B r i t i s h C o l u m b i a . corresponding  c u r r i c u l u m t h a t was u s e d i n t h i s  study  The  i sthe  Homemaker P r o g r a m o f t h e V a n c o u v e r Community C o l l e g e , V a n c o u v e r , B.C., a s t a u g h t statistical  i n 1980.  analyses  Provus Discrepancy  Methodology f o r t h i s r e s e a r c h  of t h e c l i e n t  file  included  data-and use of t h e  E v a l u a t i o n Model, i n which the a c t u a l  p r a c t i c e o f t h e homemaker a n d t h e f o r m a l c u r r i c u l u m o f homemaker training  were c o m p a r e d .  F i n d i n g s o f t h e r e s e a r c h a r e t h a t t h e c l i e n t o f 1980 a p p e a r e d t o be o l d e r , was r e p r e s e n t a t i v e o f a n u m e r i c a l l y  smaller  h o u s e h o l d , a n d d e p e n d e d on o t h e r s  homemaker a g e n c y . 1980)  Cross-tabulations  statistically  significant  who h a d p s y c h o l o g i c a l child-care  The  increase  and m e d i c a l - s u r g i c a l  problems.  However,  decreased  i n 1980.  c a t e g o r y o f homemaker p r a c t i c e , m e a n i n g t h e d u t i e s  homemaker was i n d i c a t e d a s h a v i n g been r e q u i r e d the c l i e n t ' s  statistical  change.  Cross-tabulations  care  significantly  by 1980.  with c h i l d care  of these years  and h o u s e k e e p i n g p r a c t i c e had  indicate  increased  Homemaker p r a c t i c e r e l a t e d t o a s s i s t a n c e  a n a l y s i s between t h e p r a c t i c e o f t h e  homemaker i n t h e c l i e n t ' s home a n d t h e i r  corresponding  o f t h e homemaker t r a i n i n g p r o g r a m  congruency f o r e i g h t  of the eleven  areas of d i s c r e p a n c y  w e r e : 1) r e p l a c e  (temporarily);  t o perform  i n t h e home d e c r e a s e d i n 1980.  A discrepancy  curriculum  that  home, a l s o showed a r e a s o f s i g n i f i c a n t  that personal  and  (1976 and  i n 1980 o f c l i e n t s  r e l a t e d problems f o r these c l i e n t s  significantly  in  of the years  t o the  w i t h a v a r i e t y of h e a l t h and demographic i n d i c a t o r s  display  the  for referral  2) a s s i s t w i t h  indicated  practice categories. Home C a r e  the a d m i n i s t r a t i o n  The  nurse of  medications;  3) m o n i t o r s t a t e o f h e a l t h . The  homemaker o r g a n i z a t i o n  i s a service oriented  group i n  w h i c h r a p i d r o l e c h a n g e s a r e o c c u r r i n g , a c c o m p a n i e d by t h e e v i d e n c e o f some a p p a r e n t d i s c r e p a n c i e s theory  and. a c t u a l p r a c t i c e .  between  curricular  iv  TABLE OF CONTENTS  Abstract List  i i  of Tables  v  Acknowledgement Chapter I  PROBLEM AREA  Chapter I I  LITERATURE REVIEW  vi ... .  1 10  C h a p t e r I I I CONCEPTUAL FRAMEWORK  15  Chapter IV  METHODOLOGY  19  Chapter V  RESULTS  27  C h a p t e r VI  DISCUSSION AND RECOMENDATIONS  . 67  References  79  Appendix  82  L I S T OF  TABLES  Table.I  30  Table II  31  Table I I I  32  T a b l e IV  .  Table V  33 ...  36  T a b l e VI  37  Table VII  38  Table VIII  39  T a b l e IX . .  40  Table X  41  T a b l e XI Table XII  .  42 50-  ACKNOWLEDGEMENT  S p e c i a l t h a n k s a r e g i v e n t o my t h e s i s a d v i s o r , D r . Conry, f o r h i s i n i t i a l thesis.  i n t e r e s t and c o n t i n u e d  I would a l s o l i k e  support  o f my  t o acknowledge the generous  a s s i s t a n c e t h a t I r e c e i v e d f r o m t h e homemaker a g e n c y the  Robert  i n which  r e s e a r c h was c o n d u c t e d .  This t h e s i s i s dedicated Tate.  t o my p a r e n t s , W a l t e r  a n d Vongue  1  Chapter I  PROBLEM AREA  Introduction Societal  u n d e r s t a n d i n g s about h e a l t h and h e a l t h  services  h a v e u n d e r g o n e r a d i c a l c h a n g e s w i t h i n t h e p a s t one h u n d r e d years.  P r i o r t o the nineteenth  treatment of disease were u s u a l l y c a r e d  was v e r y  t h e s t a t e o f h e a l t h and  much p e r s o n o r i e n t e d .  for in their  c o m m u n i t y members.  century,  Sickness,  homes, a t t e n d e d by f a m i l y and  aging,  e x p e r i e n c e d phenomena t h a t o c c u r r e d  and d e a t h were commonly w i t h i n t h e l i f e s p a n of  i n d i v i d u a l s ; a n d a s s u c h were u n d e r s t o o d a s b e i n g life  over w h i c h t h e i n d i v i d u a l had l i t t l e The  created  a d v e n t o f t h e germ t h e o r y  onto the disease was a d i m i n i s h i n g biological As skilled  What o c c u r r e d  concerning  was a r e f o c u s i n g  of a t t i t u d e s  the helper  There  i n t h e non-  illness.  and i n s t i t u t i o n a l l y  s e r v i c e s e t t i n g s became more  oriented,  increased.  t h e power a n d m y s t i q u e  A p r o f e s s i o n a l body o f  encompassed t h e c a u s e , e f f e c t , and t r e a t m e n t of  the  i n f i r m e d was d e v e l o p e d .  the  helping  professions  of h e a l t h c a r e  structures  century  i n t e r e s t by t h e m e d i c a l p r o f e s s i o n  a s p e c t s of  knowledge t h a t  o r no c o n t r o l .  p r o c e s s a n d away f r o m t h e i n d i v i d u a l .  professionals within health  surrounding  a s p e c t s of  i n the nineteenth  a d r a m a t i c change i n t h e b e l i e f  h e a l t h and d i s e a s e .  The s i c k  S p e c i a l i z a t i o n s w i t h i n t h e f i e l d of  increased.  and s o c i a l  The k n o w l e d g e a b o u t t h e a r e a  service assistance  became more c o m p l e x  2  as  t h e demand f o r t h e s e s e r v i c e s More r e c e n t l y , h e a l t h  additional  signs  increased.  s e r v i c e s t r u c t u r e s have begun t o show  of change.  I n t e r e s t has i n c r e a s e d  i n the  c o n c e p t of t r e a t i n g t h e w h o l e p e r s o n a s w e l l a s t h e d i s e a s e process.  A l t e r n a t i v e choices  chronically  ill,  f o r the care  and t h e dependent  B o a r d i n g homes, r e s i d e n t i a l  care  of the e l d e r l y , the  i n d i v i d u a l have a p p e a r e d .  facilities,  health  care  o r i e n t e d a p a r t m e n t c o m p l e x e s have i n many c a s e s r e p l a c e d a n d supplemented t h e asylums, orphanages, and l a r g e h o s p i t a l complexes of t h e past. long  may be due t o t h e r e a l i z a t i o n  term, i n s t i t u t i o n a l l y . b a s e d care  certain care  This  c l i e n t s and t h e b e l i e f  may be more c o s t The  mode o f c l i e n t a s s i s t a n c e  i s a social  a l t e r n a t i v e modes.of a s s i s t a n c e  consistently, the  nineteen  since  provided  shift  f o r the e l d e r l y , the Homemakers h a v e  service to the c l i e n t care  toward t h e a l t e r n a t i v e choice  assistance.  However, as  o f home a n d c o m m u n i t y the role  p r a c t i c e o f t h e homemaker a p p e a r s t o have c h a n g e d . T h e r e have been few s t u d i e s p u b l i s h e d  the  group i n  i n the  based s e t t i n g s f o r c e r t a i n i n d i v i d u a l s has i n c r e a s e d , and  It is  i n r e s p o n s e t o t h e demand  t h e i r b e g i n n i n g s a s an o c c u p a t i o n a l  thirties,  care  within the p r o f e s s i o n a l  and t h e dependent i n d i v i d u a l .  a r e a s of housekeeping and p e r s o n a l the  service, health  i n the e a r l y nineteen-hundreds.  a s e r v i c e t h a t has r a p i d l y i n c r e a s e d  ill,  situated  b e n e f i c i a l t o the taxpayer.  homemaker o r g a n i z a t i o n  chronically  care f o r  t h a t home o r community  o r i e n t e d a s s o c i a t i o n t h a t was c r e a t e d  for  i s not optimal  that  homemaker.  Therefore,  s t u d y o f t h e homemaker t h a t  that are r e l a t e d t o  the w r i t e r attempted t o create  a  i s both q u a n t i t a t i v e and q u a l i t a t i v e  3  in nature unique  i n order  t o provide a m u l t i p l e p e r s p e c t i v e of t h i s  occupation.  Specifically or d i s c r e p a n c y  the study  looked a t t h e degree of congruency  t h a t e x i s t s between t h e t h e o r y  (the formal  c u r r i c u l u m that i s taught  t o t h e homemaker) a n d t h e a c t u a l  p r a c t i c e o f t h e homemaker  i n t h e home o f t h e c l i e n t .  also  The  study  i n v o l v e d a l i m i t e d a n a l y s i s o f t h e r o l e change o f t h e  homemaker  i n B r i t i s h Columbia s i n c e the nineteen  particular  t h i r t i e s with a  f o c u s on t h e c h a n g e s t h a t a p p e a r t o have  occurred  b e t w e e n 1976 a n d 1980.  H i s t o r y o f t h e Homemaker Berger  Organization  a n d Luckman (1966) c o n t e n d  c a n n o t be a d e q u a t e l y of t h e h i s t o r i c a l  understood  process  t h a t an  unless there  institution  i s an  i n w h i c h i t was p r o d u c e d .  contemporary understanding  o f t h e homemaker  understanding Our  i s therefore  g r o u n d e d w i t h i n t h e c h a n g e s t h a t have o c c u r r e d - i n h e a l t h a n d social  s e r v i c e a s s i s t a n c e of t h e p a s t c e n t u r y , as w e l l as t h e  more s p e c i f i c  and r e g i o n a l l y d e f i n e d changes of t h e p a s t  years w i t h i n the province of B r i t i s h Historical,  documentary accounts  five  Columbia. of t h e o r i g i n s and  d e v e l o p m e n t o f t h e homemakers o r g a n i z a t i o n w i t h i n B r i t i s h Columbia e x i s t  in a limited  researchable.  T h e r e a r e few p u b l i s h e d a r t i c l e s o r u n p u b l i s h e d  studies related does e x i s t  form t h a t i s not e a s i l y  t o homemakers.  i s u s u a l l y found  The h i s t o r i c a l  information that  i n t h e form of p r i m a r y  s o u r c e s , w i t h t h e m a j o r i t y of documents b e i n g  or  situated  secondary i n the  4  files  o f homemaker a g e n c i e s  or governmental  w i t h t h e p u r c h a s i n g o f homemaker The  service.  w r i t e r , h a v i n g been g i v e n f i l e  agency, s e l e c t e d newspaper c l i p p i n g s , agency meetings, reconstructing of  access  some o f t h e h i s t o r i c a l  earliest  in British  correspondence,  t o a homemaker  brochures, minutes  and l i m i t e d c o r r e s p o n d e n c e  t h e homemaker s e r v i c e The  bodies associated  as the b a s i s f o r  b e g i n n i n g s and development Columbia.  i n t h e agency f i l e s  concerned  summary o f m i n u t e s t h a t were r e c o r d e d d u r i n g t h e f i r s t meeting In  on t h e v i s i t i n g  a  committee  homemaker i n V a n c o u v e r , J a n u a r y , 1938.  t h i s document t h e homemaker i s d e s c r i b e d a s b e i n g p r i m a r i l y a  mother  substitute.  A brochure  d e s c r i b i n g t h e r o l e o f t h e c o m m u n i t y homemaker  ( u n d a t e d ) , a l s o found  i n t h e agency f i l e s ,  historical  i n B r i t i s h C o l u m b i a as b e i n g t h e  beginnings  establishment  t h a t by 1966 t h e B.C. persons  refers  to i t s  i n 1938 o f a homemaker s e r v i c e by t h e F a m i l y  S e r v i c e s of Greater Vancouver.  The b r o c h u r e  goes on t o s t a t e  g o v e r n m e n t e x p a n d e d homemaker s e r v i c e t o  of a l l ages and f a m i l i e s of any s i z e w i t h f e e s b e i n g s e t  by a p r e d e t e r m i n e d  means t e s t .  The homemaker was d e s c r i b e d a s  someone who p r o v i d e d b o t h h o u s e h o l d to  from  clients  in their  a s s i s t a n c e and p e r s o n a l  home.  A newspaper a r t i c l e  f r o m The V a n c o u v e r S u n , F e b r u a r y  14,1973 p o r t r a y e d t h e homemaker a s b e i n g s e n t home i n c e r t a i n  into the c l i e n t ' s  s i t u a t i o n s when t h e r e i s i l l n e s s .  s t a t e d e m p h a t i c a l l y , h o w e v e r , t h a t t h e homemaker administered medication. including a f i r s t  care  This  article  never  Homemaker t r a i n i n g was d e s c r i b e d a s  a i d a n d a home n u r s i n g c o u r s e .  The V a n c o u v e r  5  V o c a t i o n a l I n s t i t u t e was s i t e d a s b e i n g  the source  o f homemaker  c u r r i c u l u m f o r the e a r l y s e v e n t i e s w i t h the program s h i f t i n g t o t h e V a n c o u v e r Community C o l l e g e by t h e m i d d l e s e v e n t i e s . . The c r e a t i o n o f The D i v i s i o n o f Long Term C a r e i n t h e B r i t i s h Columbia M i n i s t r y of H e a l t h act  in. the year  by a p r o v i n c i a l  legislative  1978 a p p e a r e d t o h a v e a m a j o r i m p a c t on t h e .  growth and development of t h e o c c u p a t i o n  o f homemaking.  F o l l o w i n g t h e d e p a r t m e n t ' s c r e a t i o n , t h e number o f homemaker agencies  i n c r e a s e d by a f a c t o r o f t e n f r o m 1970 t o 1980.  I n a document s e n t  t o homemaker a g e n c i e s  B r i t i s h Columbia M i n i s t r y of H e a l t h , P r o g r a m o f L o n g Term C a r e , J a n u a r y philosophy ministry  of long  term care  1, 1978, d e s c r i b e d t h e  i n t h e f o l l o w i n g manner.  special assistance.  should  be p r o v i d e d  service, institutional  i n t e r m e d i a t e , and e x t e n d e d c a r e  f o r those  assessed  optimal  support  care at the personal,  l e v e l s was a l s o t o be made  The o b j e c t i v e s o f t h e L o n g Term C a r e p r o g r a m independence  health l e v e l s f o r the c l i e n t .  Newspaper a r t i c l e s Province  needing  as being i n  o u t l i n e d and s t r e s s e d the importance of m a i n t a i n i n g and  The  that i n d i v i d u a l s  I n a d d i t i o n t o t h e home c a r e  t h a t was t o be made a v a i l a b l e f o r t h o s e  available.  interest in  i n t h e i r homes f o r a s l o n g a s p r a c t i c a l a n d  d e s i r a b l e and t h a t s u p p o r t  need o f t h i s  The  based program of long term c a r e .  e l e m e n t o f s u c h a p r o g r a m was t h e b e l i e f  w o u l d want t o s t a y  this  i n i t s I n t r o d u c t i o n t o the  s t a t e d t h a t t h e r e h a d been a l o n g s t a n d i n g  creating a provincially key  i n 1978, t h e  s u c h as. t h e one t h a t a p p e a r e d i n The  ( V a n c o u v e r ) on J a n u a r y 5, 1978, a t t h e b e g i n n i n g  L o n g Term C a r e p r o g r a m , e m p h a s i z e d t h e i m p o r t a n c e o f  of t h e  keeping  6  individuals f r o m The that  i n home s e t t i n g s w h e n e v e r p o s s i b l e .  Province  also stressed  the  the  l e v e l s of By  demand and  the  cost  1979,  issue  however, t h e r e  r e l a t e d to the  was  of more e x t e n s i v e  Colonist  an  occasional  the  service association  to provide  as  by  around the  (Victoria) reporter  concerns that  The  the  f o r the  were t h e  level  client.  On  q u o t e d the  h o u r s of  J u n e 11,  president  service  the  seemed t o be  service  i n c l u d e a new  and  client  in addition  often  complexity 1979,  in  steadily  complexity.  increasing,  required. the  nineteen  oriented  f o c u s of  long  t e r m and  chronic  complicated personal  to housekeeping  client  in nature.  care  assistance  services.  T h e s e p a r t i c u l a r f a c e t s o f homemaker r o l e c h a n g e and t r a i n i n g and  p r a c t i c e o f homemakers w i l l  the  presentation  research  and  a  c r i s e s to  much more c o m p l e x d i m e n s i o n o f t h e  required  a  voicing  increasing  short-term, family  whose needs, were f r e q u e n t l y  homemaker  homemakers were e x p e c t e d  o c c u p a t i o n of homemaking s e r v i c e s by  primary concern with  raise  of a community  i n B r i t i s h C o l u m b i a as  of  client  appearing  seemed t o  e i g h t i e s a p p e a r e d t o have s h i f t e d f r o m i t s i n i t i a l  This  in  costly  article  increasing  number o f c l i e n t s were o b s e r v e d t o be  The  and  a c c e l e r a t i n g d e v e l o p m e n t of  That i s s u e c e n t r e d  care being required  social  view  care.  services. of  of  a positive factor  i n t h e s e c o l l e c t i o n s of n e w s p a p e r c l i p p i n g s t h a t a new  article  government's p o i n t  homemaker s e r v i c e s were assumed t o be  reducing  This  analysis  be  the  examined f u r t h e r  chapters.  in  7  Development The of  o f t h e Homemaker  records  research  o f t h e homemaker a g e n c y t h a t h a s been t h e  for this  f i v e percent  Curriculum  t h e s i s indicated that approximately  o f i t s homemakers c o m p l e t e d t h e V a n c o u v e r  C o l l e g e Homemaker T r a i n i n g P r o g r a m . remaining  focus  fifty Community  Homemaker t r a i n i n g  f o r the  homemakers c o n s i s t e d p r i m a r i l y o f b r i e f o r i e n t a t i o n  s e s s i o n s and an o n - g o i n g i n - s e r v i c e p r o g r a m t h a t was  taught  by  a g e n c y s u p e r v i s o r s and a v a i l a b l e t o a l l o f t h e a g e n c y ' s homemakers. T h e r e h a v e n e v e r been any c o m p u l s o r y e d u c a t i o n a l requirements i n B r i t i s h  C o l u m b i a f o r t h e homemaker who i s  e m p l o y e d by a homemaking a g e n c y . the problems t h a t recommendations  i t represents  chapter  of t h i s  This will  specific  researched,  thesis.  :  Since  i t was c h o s e n a s b e i n g  the teaching  t h e most a p p r o p r i a t e  There are other  of B r i t i s h Columbia.  t h i s t h e s i s t o comment on t h e s e  training  evaluation  and p r a c t i c e o f t h e p a r t i c u l a r  c u r r i c u l a t h a t have been t a u g h t  specifically  curriculum  t o a m a j o r i t y of homemakers f r o m t h e a g e n c y  homemakers u n d e r s t u d y .  province  the Vancouver  the formal  p r o g r a m t o use a s t h e b a s i s f o r a d i s c r e p a n c y concerning  and  be f u r t h e r a d d r e s s e d i n t h e  Community C o l l e g e c u r r i c u l u m r e p r e s e n t s t h a t has been t a u g h t  situation  g r o u p of  f o r m s o f homemaker  and d e v e l o p e d w i t h i n t h e However, i t i s not t h e p u r p o s e of programs  but t o l o o k  a t the c u r r i c u l u m t h a t c o n s t i t u t e s the major  e d u c a t i o n a l component f o r t h e f o r m a l  training  f r o m t h e a g e n c y t h a t h a s been t h e f o c u s The d o c u m e n t ,  Development  o f t h e homemakers  of t h i s  thesis.  of the Vancouver C i t y  Homemaker P r o g r a m - R e p o r t o f P h a s e I I I , p u b l i s h e d  College  i n 1978,  8  i n d i c a t e s c l o s e h i s t o r i c a l t i e s between f a m i l y o r g a n i z a t i o n s and  the  e a r l y g r o w t h and  educational  of t h e Homemaker P r o g r a m i n B r i t i s h C o l u m b i a . S e r v i c e s C e n t e r s met Vocational  Institute,  P r o g r a m " be pilot  with  training  An  p r o g r a m was  Vancouver V o c a t i o n a l program to t r a i n t h e D e p a r t m e n t of  advisory  program t h a t c e n t r e d housecleaning, In  1966  training  there  was  The  In  P r o g r a m was  needed.  and  Aide  Aide Program. food  This  the T r a i n e d and  was  a  needs. formal  the  Family  than the T r a i n e d  s i x weeks of t r a i n i n g  by  preparation,  above s t a t e s t h a t  program o t h e r  within Family  Aid  Homemaker including  than that provided  by  the  Program.  1969  t h e p r o g r a m was  meet what a p p e a r e d t o be  care  e x t e n d e d t o e i g h t weeks i n o r d e r  t h e more c o m p l e x n e e d s o f t h e  V a n c o u v e r Community C o l l e g e personal  funded  provincial  a push t o d e v e l o p s p e c i f i c ,  t o p i c s w i t h a b r o a d e r b a s e of t h e o r y  In  the  human b e h a v i o u r  T h i s p r o g r a m was  P r o g r a m , c o n s i s t i n g of  Family  1965,  Family  document c i t e d  this period a specific  a  the  a l s o d e v e l o p e d and  p r o g r a m s f o r t h e homemakers e m p l o y e d by  Service Centers.  f o r m e d and  s i t u a t e d at  around t o p i c s such as:  home n u r s i n g ,  Training  Subsequently, a housekeeping  Affairs.  government a p p r o v e d the T r a i n e d  Family  Vancouver  c o m m i t t e e was  d e v e l o p e d and  women was  Indian  1964  t h a t a "Housekeeping  Institute.  Indian  development  In  r e p r e s e n t a t i v e s of t h e  requesting  developed.  service  records  n e e d s of t h e c l i e n t  t a u g h t by V.C.C., was  intensified,  client  was  put  reflecting into  place  client.  i n 1975,  the program,  e x t e n d e d t o a p e r i o d of t w e l v e  subsequently revised curriculum t h e homemaker and  also state that  to  as then  weeks.  A  the c h a n g i n g needs of i n 1978.  By  1980  9  t h e homemaker p r o g r a m h a d been e x t e n d e d course Evening  t o a . t h i r t e e n week  f o r t h o s e e n r o l l e d i n t h e f u l l - t i m e day s e s s i o n s . sessions  were a l s o o f f e r e d , c o n s i s t i n g o f one s e s s i o n a  week f o r a p p r o x i m a t e l y one y e a r . A d d i t i o n a l documents and d i s c u s s i o n s between t h e w r i t e r and t h e V a n c o u v e r Community C o l l e g e indicate that the curriculum with  curriculum  i s experiencing  revisions especially reflecting  Term C a r e  developers  an o n - g o i n g  review  t h e i m p o r t a n t r o l e o f Long.  i n t h e a r e a o f homemaker s e r v i c e s .  a l s o appear t o r e f l e c t  i n 1980  the r a p i d l y changing  These r e v i s i o n s nature of the  homemaker's r o l e a n d t h e i n c r e a s i n g demands t h a t a r e b e i n g placed  on homemaker a g e n c i e s a n d t h e c u r r i c u l u m  terms of p r o v i d i n g both housekeeping to the c l i e n t  developers i n  and h e a l t h c a r e  assistance  10  Chapter I I  LITERATURE REVIEW  Introduction A search  of the l i t e r a t u r e  homemakers r e v e a l s available. two  that there  The l i t e r a t u r e  r e l a t e d t o the t o p i c of the  is little  research  material  t h a t d o e s e x i s t c a n be d i v i d e d  into  areas: 1)  studies  that are p r i m a r i l y d e s c r i p t i v e i n nature, i n  which the contemporary r o l e or the f u t u r i s t i c the 2)  homemaker was  studies  r o l e of  delineated;  r e l a t e d t o t h e c o s t - e f f e c t i v e n e s s o f homemaker  services. T h e r e d o e s n o t a p p e a r t o be any p u b l i s h e d concerned with the  theory  research addressed  research  that i s  t h e a n a l y s i s of congruency or d i s c r e p a n c y  a n d t h e p r a c t i c e o f t h e homemaker.  w i t h i n t h i s p a r t i c u l a r area i n subsequent c h a p t e r s .  between'  The l a c k o f  i s an i s s u e t h a t w i l l  The r e s e a r c h  studies  be  t h a t do  e x i s t a r e u s e f u l f o r t h e p u r p o s e o f d e l i n e a t i n g some o f t h e observations  and c o n c e r n s t h a t  There i s l i t e r a t u r e occupation  other  researchers  have  on t h e t o p i c o f homemaking a s an  a v a i l a b l e from b o t h A m e r i c a n and C a n a d i a n  Numerically,  there  noted.  sources.  a r e more A m e r i c a n a r t i c l e s a v a i l a b l e .  H o w e v e r , t h e C a n a d i a n l i t e r a t u r e a p p e a r s t o be much more a p p l i c a b l e t o t h e s t u d y o f t h e homemaker w i t h  i n the context  of  11.  B r i t i s h C o l u m b i a b e c a u s e t h e p r o v i s i o n of s o c i a l services differs  Literature The during  i n the  two  from the U n i t e d  articles  descriptive  in nature.  States  of t h e  described  as b e i n g  homemaker was was  family.  utilized  S t a t e s were w r i t t e n p r i m a r i l y  s e v e n t i e s and  were  principlely  These d e s c r i p t i v e s t u d i e s p o r t r a y  r o l e o f t h e homemaker a s b e i n g context  one  In these  crisis  the  s t u d i e s t h e homemaker was  a mother s u b s t i t u t e o r mother h e l p e r .  in short-term  situations.  " A n a l y s i s of T a s k s i n T h r e e Home R e l a t e d and  the  t h a t i s grounded w i t h i n  f r e q u e n t l y r e f e r r e d t o as b e i n g  (Shipley,1967)  medical  countries.  from the U n i t e d  t h e s i x t i e s and  and  " S u p e r v i s i o n of the  an  often The  individual  The  who  studies,  Occupations"  Paraprofessional"  ( R i p p l e , 1 9 7 3 ) , b o t h d e s c r i b e a homemaker as b e i n g  essentially  m a t u r e i n d i v i d u a l who  in family  settings.  She  was  helps  or r e p l a c e s t h e . m o t h e r  seen as b e i n g  perform household d u t i e s i n order n o r m a l i z a t i o n of study who  family l i f e  a p e r s o n who to a s s i s t  during periods  was  with  t r a i n e d to the  of s t r e s s .  f r o m t h i s p e r i o d r e f e r s t o t h e homemaker as an  c o u l d combine both the  (Lewis  and  Scheuren, 1975).  Scheuren study  was  nonprofessional. occasion  The  also described The  of homemaking and  Another  individual home n u r s i n g  homemaker i n t h e L e w i s as b e i n g  homemaker was  demanded, be p r e p a r e d  a s s i s t a n c e and client.  skills  unliscensed  someone, who  a  and and  w o u l d , when  to give both personal  a s s i s t a n c e with housekeeping d u t i e s to  care the  the  12  The studies  literature that  from t h e U n i t e d  were c o n c e r n e d w i t h  homemaker s e r v i c e s . utility  States  also contains  some  t h e c o s t - e f f e c t i v e n e s s of  One o f t h e s e s t u d i e s , w h i c h a s s e s s e d t h e  o f homemaker s e r v i c e a s an a l t e r n a t i v e t o a v a r i e t y o f  more e x p e n s i v e a n d c o m p l e x f o r m s o f i n s t i t u t i o n a l t h a t homemaker s e r v i c e c o u l d  be g e n e r a l l y  care,  described  found  as b e i n g  more c o s t - e f f e c t i v e t h a n any o f t h e o u t - o f - h o m e a l t e r n a t i v e s surveyed  (Robinson,  1974).  Canadian L i t e r a t u r e The of the  three  Canadian l i t e r a t u r e research  studies.  r e l a t e d t o t h e homemaker These Canadian s t u d i e s  consists  also  d e s c r i p t i v e a s p e c t s o f t h e homemaker a n d t h e i s s u e  cost-effectiveness first  address of t h e  o f homemaker s e r v i c e t o t h e c l i e n t .  of these s t u d i e s ,  " V i s i t i n g Homemaker S e r v i c e  The  i n Canada:  R e p o r t o f a S u r v e y w i t h R e c o m m e n d a t i o n s " , s p o n s o r e d by t h e Canadian Council  on S o c i a l D e v e l o p m e n t  homemaker a s someone who p r o v i d e d service.  She was r e s p o n s i b l e  mother i n f a m i l y of  service.  financial could  settings.  I t stated  statistics  be a s s e s s e d .  that  an o r g a n i z e d  the  community  f o r a s s i s t i n g or r e p l a c i n g the  This there  report  also o u t l i n e d the costs  was no s i m p l e f o r m u l a b a s e d on  by w h i c h c o s t s This  (1971), described  same r e p o r t  and b e n e f i t s  to clients  a l s o addressed the t r a i n i n g  of  t h e homemaker.  The f i n d i n g s were t h a t  of  t r a i n i n g f o r homemakers v a r i e d w i d e l y  the t r a i n i n g or lack a c r o s s Canada.  recommendations t h e c o u n c i l p r e s e n t e d as i t s f i r s t  In i t s  priority for  13  a c t i o n t h a t homemaker s e r v i c e be r e c o g n i z e d utility,  one t h a t  community.  The the  a public  i s a v a i l a b l e and a c c e s s i b l e t o t h e whole  The s t u d y a l s o s t r e s s e d  evaluation  as being  the importance of on-going  o f homemaker t r a i n i n g p r o g r a m s .  r e m a i n i n g two C a n a d i a n s t u d i e s were r e s e a r c h e d  lower mainland of B r i t i s h Columbia.  R e p o r t on Homemakers and R e l a t e d (Mercer,  In a study  Services  assistance  entitled:  i n Greater  1 9 7 4 ) , homemaker s e r v i c e was d e s c r i b e d  within  Vancouver  as p r o v i d i n g  o r mother r e p l a c e m e n t i n f a m i l y s e t t i n g s and as  giving help  to the chronic  or convalescent  described  the t y p i c a l c l i e n t  seventies  as r e q u i r i n g a s s i s t a n c e  situations. .Personal  care  adult.  i n the period  only  report  of t h e e a r l y  i n short-term,  involved  This  stress related  19% o f a l l s e r v i c e s  surveyed. The  last  of the Canadian l i t e r a t u r e  s t u d y p r e p a r e d by t h e S o c i a l P l a n n i n g B r i t i s h Columbia Service  legislative  and R e v i e w C o u n c i l o f  (S.P.A.R.C.) i n 1977.  f o r E l d e r l y P e r s o n s i n B.C.  t o be r e v i e w e d was a  This  report,  , surfaced  a d d r e s s e d t h e need f o r p r i o r i t i e s  senior c i t i z e n s . service  j u s t p r i o r to the  a c t i o n s o f t h e B r i t i s h C o l u m b i a g o v e r n m e n t i n 1978  when t h e p r o g r a m o f L o n g Term C a r e was c r e a t e d . report  Homemaker  The  i n community c a r e f o r  The m a j o r r e c o m m e n d a t i o n was t h a t  f o r the e l d e r l y should  S.P.A.R.C.  homemaker  be u n i v e r s a l l y p r o v i d e d  on t h e  b a s i s of a h e a l t h / s o c i a l needs assessment and t h a t  i t should  a v a i l a b l e under a form of comprehensive c a r e .  S.P.A.R.C.  The  s t u d y a l s o s t a t e d t h a t p u b l i c f i n a n c i n g o f in-home c a r e e x p e n s i v e t h a n was t h e f i n a n c i n g o f c o m p a r a b l e care  and t h a t  be  was l e s s  institutional  i t was a l m o s t a l w a y s more s a t i s f a c t o r y t o t h e  14  client. The C a n a d i a n l i t e r a t u r e set  indicates  f o r t h e enactment of l e g i s l a t i o n  financing  the stage that  regarding  o f homemakers; a l e g i s l a t i v e a c t i o n  b o t h t h e homemakers a n d t h e i r  clients.  was  being  Long Term C a r e that  was t o a f f e c t  15  . Chapter I I I  CONCEPTUAL FRAMEWORK  Framework D e s i g n The  conceptual  f r a m e w o r k f o r t h i s p a p e r was  s o c i o l o g i c a l base of  inquiry.  w r i t i n g s of B e r g e r and sociology  of  The  Luckman  knowledge.  primary foundation  (1966) i n t h e  Secondarily,  s e r v i c e s has  B e r g e r and as  being  Sociology The  sociology  r o l e c h a n g e and  particular o f how the  the  of h e a l t h c a r e  and  writings'of  i n q u i r y were a l s o  a n o t h e r , and  complex f a c t o r s t h a t  Maclntyre  chosen  of p a r t i c u l a r v a l u e  i n f l u e n c e the  homemaker.  of  knowledge a p p r o a c h , as p o s t u l a t e d  the e d u c a t i o n a l  i s s u e s of  can  be  viewed.  field  of  s o c i o l o g i c a l i n q u i r y , look  k n o w l e d g e comes t o be  B e r g e r and  socially  p u r p o s e s o f homemaker r e s e a r c h  historical  by  Luckman ( 1 9 6 6 ) , i s a u s e f u l f r a m e w o r k a g a i n s t  organization  For  the  modes of  the  homemaker t o be,  which  homemaker  Luckman, i n  their  at the  e s t a b l i s h e d as  question reality.  t h i s approach e n t a i l s a  u n d e r s t a n d i n g of what s o c i e t y i n t h e  understood the  a  the  of Knowledge A p p r o a c h  B e r g e r and the  T h e s e two  c o m p l i m e n t a r y t o one  in researching  a r e a of  been c h o s e n t o augment t h e  Luckman.  is  t h e w r i t i n g s of  (1977) c o n c e r n i n g c o n f l i c t i n g p e r s p e c t i v e s social  designed with  what were h e r  past  has  r o l e s , and  what  16  was  her p e r c e i v e d  function within society.  r o l e and  f u n c t i o n , what was  what was  t h e s c o p e and  t h a t we  Adjunctive  she t a u g h t a b o u t  l i m i t a t i o n s of t h a t  r e f e r t o as b e i n g  t o her  homemaking,  body o f  homemaker c u r r i c u l u m .  and  knowledge  Specifically,  B e r g e r and Luckman r e f e r t o s u c h a g r o u p as t h e homemakers as being  representative  institutional  concept  has been s e t a s i d e as a g r o u p part. with  o f an  i s that  i s an  t h e i r , r o l e and  as b e i n g  part  itself  purpose.  Their  i m p l i e d body o f k n o w l e d g e t h a t f u n c t i o n and an  to the c l i e n t .  more c o n d u c t  The which  existance  by t h e s o c i e t y o f w h i c h t h e y a r e a  o v e r what t h e y c a n and c a n n o t service  concept.  t h e homemakers a r e a g r o u p  f o r some s p e c i f i c  i s recognized  There  institutional  i s associated  implied external  do as t h e y p r o v i d e  control  homemaker  B e r g e r and Luckman a l s o s t a t e t h a t  is institutionalized,  or seen and  accepted  o f commonplace a c t i v i t e s w i t h i n our l i v e s ,  t h e more p r e d i c t a b l e and c o n t r o l l e d t h e a c t i v i t y as t h e homemakers s h o u l d  the  then  of groups  such  become.  Homemaker R o l e s In t e r m s r o l e s may contend  o f t h e r o l e s t h a t homemakers p l a y  have changed over the y e a r s ,  that a l l i n s t i t u t i o n a l i z e d  homemaking, i n v o l v e s t h e c o n c e p t individual  i s part  individual will  conduct,  of a r o l e .  I f t h e r o l e and  such as t h a t The  (1966) of  r o l e of  an  of  role stability  i s i n d e e d c r u c i a l as a c o n t r o l f a c t o r , then  a r i s e i n s i t u a t i o n s i n which  these  B e r g e r and Luckman  of the c o n t r o l l i n g c h a r a c t e r  institutionalization.  and how  of  the  problems  the i n d i v i d u a l ' s r o l e i s  17  r a p i d l y changing.  The f i n d i n g s o f t h i s  t h e s i s study  indicate  that  t h e r o l e o f t h e homemaker i n 1980 i s n o t c o n g r u e n t w i t h h e r  role  i n 1976.  Given the r a p i d l y i n c r e a s i n g c o m p l e x i t y of c l i e n t  n e e d s , t h e r o l e o f t h e homemaker may c o n t i n u e t o c h a n g e . The  institutional  constraints  homemaker a l s o a p p e a r t o d e f i n e client.  that  are placed  her r o l e of s e r v i c e t o t h e  B e r g e r a n d Luckman s t a t e t h a t  human c o n d u c t by e s t a b l i s h i n g p r e d e f i n e d  institutions patterns  w h i c h c h a n n e l i t i n one d i r e c t i o n a s a g a i n s t directions  that  on t h e  of conduct  t h e many o t h e r  t h e o r e t i c a l l y w o u l d be p o s s i b l e .  The homemaker  i s d i r e c t e d by t h e homemaker a g e n c y a s t o c e r t a i n duties  that  further training  she i s t o p r o v i d e  Ideally, the  prescribed  for specific clients.  l i m i t e d i n her patterns she h a s o r h a s n o t  control  o f c o n d u c t by t h e  She may. be educational  received.  the r o l e , theory,  a n d p r a c t i c e o f a body s u c h a s  homemakers s h o u l d mesh t o g e t h e r w i t h i n a g e n e r a l i z e d  of c o n g r u e n c y . outlined  pattern  H o w e v e r , i n t h e c a s e o f t h e homemakers a s  i n t h i s t h e s i s , there  a p p e a r s t o have been r a p i d  change and c o r r e s p o n d i n g a r e a s of d i s c r e p a n c y between ( t r a i n i n g ) and a c t u a l p r a c t i c e .  When t h i s o c c u r s ,  role  theory  both the  homemaker's u n d e r s t a n d i n g s o f who she i s a n d what s e r v i c e s she s h o u l d be g i v i n g t o t h e c l i e n t may be d i s t o r t e d .  The  u n d e r s t a n d i n g s of s o c i e t y a t l a r g e as t o the r o l e of t h e homemaker may a l s o be p o o r l y  Conflicting Perspectives A second v i e w p o i n t  defined.  i n Health  C a r e and S o c i a l  Services  from w h i c h t h e r o l e and f u n c t i o n  of t h e  18  homemaker c a n  be  understood  i s derived  w r i t i n g s of S a l l y M a c l n t y r e . 1977)  One  from the s o c i o l o g i c a l  p a r t i c u l a r study  o u t l i n e s a d u a l i t y of c o n c e p t s w i t h i n t h e  care  and  social  service.  In her  as a s o c i a l p r o b l e m as  She  though, t h a t her  only  out,  t o the  p r o b l e m of o l d age,  in England there  between the  o r g a n i z a t i o n a l and  within  the  last  perspective general),  century  o l d age  but  being  to the  perspective  In the  p r i m a r i l y on  the  relevance  problematic  social  tension  perspective  dependency i n  f o r the o f how  individual.  The  best to prevent  d e p e n d e n c y by them.  The  d e p e n d e n c y as is  The  component h e r e i n v o l v e s a c o n s i d e r a t i o n  of how  best to  the  i n d i v i d u a l s who It w i l l and of  the the  placed  on  the  c o m m u n i t y by  require health care  and  social  argued i n t h i s  thesis that  organizational perspective homemakers.  in determining only  be  that are  the  T h e s e two  are  homemaker, t h e c l i e n t ,  and  society in  a  social  placed  action reduce  these  humanitarian  w i t h i n the  particularly  some o f t h e c o m p l e x f a c t o r s t h a t  the  assistance.  both the  operative  concepts are  these  organizational  i s a burden of dependency t h a t members of  action,  reducing  society.  social costs  She  because i t encompasses  c h r o n i c i t y , and  productive  not  humanitarian  c h r o n i c i t y and  i n d i v i d u a l experiencing  problem because there  the  dependency i n g e n e r a l .  c h r o n i c i t y , and  s e e s o l d age,  health  research.  a l s o t o h e a l t h and  a half.  component c o n c e r n s t h e q u e s t i o n  costs  i s of  the h u m a n i t a r i a n  observable costs  p r o b l e m s of o l d age,  b a s i s of  a p p e a r s t o have been  (as w e l l as  i s s e e n as  s u f f e r i n g and  and  the  research  s e r v i c e p r o b l e m s of c h r o n i c i t y and stated that  a r e a of  s t u d i e s M a c l n t y r e used  i s s u e o f o l d age pointed  (Maclntyre,  useful  influence general.  area  not  19  Chapter IV .  METHODOLOGY  Overview Instrumentation specific  for the research  was c h o s e n w i t h t h e  i n t e n t o f a n a l y z i n g t h e - r o l e change o f t h e homemaker  over a d e f i n e d p e r i o d of time and t h e d i s c r e p a n c y e x i s t between t h e c u r r i c u l a r homemakers i n t h e c l i e n t ' s For  theory  t h a t might  and t h e a c t u a l p r a c t i c e of  home.  t h e p u r p o s e o f c o m p a r i s o n , one h u n d r e d c l i e n t  e a c h f r o m 1976 a n d f r o m 1980 were r a n d o m l y s e l e c t e d . years  prior  t o and f o l l o w i n g t h e i n t r o d u c t i o n of t h e  L o n g Term C a r e l e g i s l a t i o n  these data  These  were c h o s e n so t h a t t h e r o l e a n d p r a c t i c e o f t h e homemaker  c o u l d be a s s e s s e d  file  files  data  i n 1978. Content a n a l y s i s of t h i s  was u s e d t o r e d u c e t h e i n f o r m a t i o n c o n t a i n e d  client  files  gathering  t o t h e form o f manageable u n i t s .  was c o m p l e t e d , c o n t e n t  within  After the  reduction of t h i s data t o  mutually  e x c l u s i v e u n i t s o f i n f o r m a t i o n was t h e n e m p l o y e d .  prepared  c a t e g o r i e s of i n f o r m a t i o n obtained  1980  client  Statistical The  f i l e s were t h e n s t a t i s t i c a l l y  f r o m t h e 1976 a n d  compared u s i n g t h e  Package f o r t h e S o c i a l S t u d i e s program  next step  The  i n the methodology design  (S.P.S.S.).  was t o compare t h e  practice categories obtained  w i t h t h e 1980 c u r r i c u l u m o f t h e  homemaker t r a i n i n g p r o g r a m .  The P r o v u s D i s c r e p a n c y  (Provus, an  1971) was u s e d i n t h i s  evaluative tool  that allows  instance.  Model  The P r o v u s M o d e l i s  f o r t h e a n a l y s i s of congruence  20  a n d / o r d i s c r e p a n c y b e t w e e n c u r r i c u l a r . t h e o r y and curricular  t h e o r y was  p r o g r a m as  t a u g h t by  that  that.of the  c o r r e s p o n d s to the  homemakers w i t h i n The  final  interviews  the  the  s e r v e d t o expand the regarding  t r a i n i n g received  of  the.role  and  available  for analyzing  q u e s t i o n s about the of  creating  t h e o r y , and  Content  the  not  some of  homemakers but  focussed  field interviews  from a l l s o u r c e s ,  for t h e i r a b i l i t y  underlying  the  the  v i e w of  practice within  specified period  to  conceptual purpose i n mind  homemaker's r o l e , of  time.  Analysis  (1969) was  used s p e c i f i c a l l y  f o r the  amount of d e s c r i p t i v e m a t e r i a l homemakers and  from the  systematically this material  p u r p o s e of  r e l a t e d t o the  f o r m of m a n a g e a b l e u n i t s .  obtained  as d e s c r i b e d  by  Holsti  reducing  practice  extracted  writer  a b o u t homemaker p r a c t i c e  and  for  initially  the  client  Content a n a l y s i s provided  c l i e n t ' s case notes could  identified,  the  of  biodemographic c h a r a c t e r i s t i c s about the  t e c h n i q u e whereby i n f e r e n c e s  The  of  The  also with  In t h i s t h e s i s c o n t e n t a n a l y s i s  to the  that  a multi-dimensional the  the  homemaker.  only the  of  for t h i s thesis.  e m p l o y e d was  t r a i n i n g of  a program  a majority  agency b e i n g s t u d i e d .  T h e s e methods were s e l e c t e d provide tools  by  data from r e p r e s e n t a t i v e  information  The  homemaker t r a i n i n g  V a n c o u v e r Community C o l l e g e ;  m e t h o d o l o g y t o be  within  1980  agency r e s e a r c h e d  consisting  supervisors  the  practice.  be  a  data  objectively  and  s p e c i f i c c h a r a c t e r i s t i c s of  analysis.  f o r m u l a t e d a s e r i e s of  biodemographic  21  and be  homemaker p r a c t i c e a r e a s o f i n t e r e s t t h a t were e x p e c t e d t o found w i t h i n the c l i e n t  file  information.  c l i e n t ' s age; s e x ; area of c i t y the  These were: t h e  r e s i d i n g i n ; method o f r e f e r r a l ;  number i n t h e f a m i l y u n i t o f t h e c l i e n t ;  assistance practice  was r e q u i r e d  seen as being theoretical recognized  order  by t h e homemaker; a n d t h e a r e a s o f  t h e homemaker was r e c o r d e d a s h a v i n g p e r f o r m e d  c l i e n t ' s home.  precise  t h e r e a s o n ( s ) why  Careful construction  of these  an i m p o r t a n t p r e l i m i n a r y  step  categories.was  i n meeting both the  r e q u i r e m e n t s of t h e problem a t hand, as w e l l as t h e canons of c a t e g o r y c o n s t r u c t i o n .  operational  that  i n the  definition  the coding  could  of c a t e g o r i e s  was d e c i d e d upon i n  proceed with acceptable  reliability,  a s h a s been s u g g e s t e d by H o l s t i  in  of c o n t e n t a n a l y s i s  the f i e l d  Additionally, a  l e v e l s of  and other  (Holsti,1969).  writers  The w r i t e r  also  chose t h e use of c o n t e n t a n a l y s i s f o r t h i s p a r t i c u l a r t a s k of information the  a n a l y s i s b e c a u s e a l l c o n t e n t a n a l y s i s i s b a s e d upon  c o m p a r a t i v e mode ( H o l s t i ,  mutually easily  1969).  By r e d u c i n g  information  e x c l u s i v e u n i t s , t h e homemaker c a s e n o t e d a t a c o u l d  tabulated  and c r o s s  to be  referenced.  A n o t h e r , c o n c e r n o f t h e w r i t e r was w i t h i n t h e a r e a o f o b j e c t i v e as opposed t o s u b j e c t i v e particular entered during the  specific  f i l e s were c o m p i l e d by f i e l d data a t the time of c l i e n t  t h e months o r y e a r s t h e c l i e n t ' s  gathering.  processing  file  this  These  supervisors,  who  and  was a c t i v e .  c o n t e n t a n a l y s i s method o f r e t r i e v i n g i n f o r m a t i o n  client in  client  information  Using  about  c h a r a c t e r i s t i c s a n d homemaker p r a c t i c e , i t was p o s s i b l e instance  technique  t o make u s e o f an u n o b t r u s i v e  (Webb e t a l . , 1 9 6 6 ) .  Information  research w r i t t e n at the time  22  in which there  i s ongoing  i n t e r a c t i o n between a  s u p e r v i s o r , a homemaker, and vignette.  Salancik(1965)  Webb and  documentary evidence events; past The  a client  as b e i n g  field  provides a unique  described this  other  the  recollections.  a n a l y s i s f u r t h e r e l i m i n a t e d the p o s s i b l e  of d a t a  f o r m s of d a t a  of  d o c u m e n t s r e v e a l s more of  t h a n w o u l d be p o s s i b l e i n v o l u m e s of v e r b a l  contamination  k i n d of  f a r s u p e r i o r t o the r e c a l l  t h e p a l e s t i n k of t h e s e  method of c o n t e n t  data  t h a t m i g h t have o c c u r r e d  w i t h t h e use  g a t h e r i n g ; forms i n which  between the. r e s e a r c h e r  and  information could affect  interaction  the;subject generating  the nature  of t h e  of  and  response  recording (Holsti,.  1969). The  biodemographic  difficulty The  and  category  requested  recorded  of c l i e n t  i n f o r m a t i o n was i n the  form of m u t u a l l y  diagnosis  (or the reason  However, t h e a r e a  r e q u i r e d much more e x h a u s t i v e  notes  about.  r e d u c t i o n of p r a c t i c e n o t a t i o n t o m u t u a l l y  in  o b t a i n e d a f t e r many r e a d i n g s order  t o d e t e r m i n e how  and  many t i m e s  the  client  retrieved  the w r i t e r  t o manageable  u l t i m a t e g o a l f o r t h i s more c o m p l e x a r e a  d e t e r m i n e what t h e c o m m u n i c a t i o n was  was  why  in  of homemaker p r a c t i c e  a n a l y s i s before  a b l e to reduce the e x t e n s i v e c l i e n t  without  exclusive units.  a s s i s t a n c e f r o m t h e homemaker a g e n c y ) was  a s i m i l a r manner.  The  retrieved  was units.  of a n a l y s i s was This goal  of  exclusive categories  r e - r e a d i n g s of c l i e n t and  to  w i t h what  files  variation  c e r t a i n homemaker p r a c t i c e c a t e g o r i e s a p p e a r e d f o r e a c h  client.  As H o l s t i  of  content  (1969)  analysis,  subject being  has  noted  in his research  i n the  field  t h e theme, t h e s i n g l e a s s e r t i o n a b o u t  the  i n v e s t i g a t e d , i s o f t e n t h e most u s e f u l u n i t of  23  content  analysis.  Once t h e c o n t e n t a n a l y s i s was c o m p l e t e d ,  and t h e s e  specific  c a t e g o r i e s r e c o r d e d , t h e n e x t p h a s e was t h e s t a t i s t i c a l  analysis  of t h e c l i e n t  Statistical  case  note  data.  Package f o r the S o c i a l  The S t a t i s t i c a l  P a c k a g e f o r t h e S o c i a l S c i e n c e s was c h o s e n  f o r use i n t h e s t a t i s t i c a l the c l i e n t  files.  Sciences  a n a l y s i s of t h e data generated  The S.P.S.S.  i s an i n t e g r a t e d s y s t e m o f  c o m p u t e r p r o g r a m s t h a t h a s been d e s i g n e d a n a l y s i s of s o c i a l are- e s p e c i a l l y simple  frequency  The P r o v u s  science data.  useful  specifically  Discrepancy  f o r the  I t c o n t a i n s procedures  for obtaining descriptive  distributions,  from  and c r o s s  that  statistics,  tabulations.  Model  A central question for this evaluative thesis  i s the extent  of c o n g r u e n c y o r d i s c r e p a n c y b e t w e e n t h e c u r r i c u l u m o f t h e f o r m a l t r a i n i n g p r o g r a m f o r t h e homemakers b e i n g r e s e a r c h e d and the areas of p r a c t i c e  i n which  t h e home o f t h e c l i e n t . Evaluation which  (Provus,  she i s t y p i c a l l y  The P r o v u s  engaged  within  D i s c r e p a n c y Model of  1971) was c h o s e n a s an a p p r o p r i a t e t o o l by  t h e s e a r e a s o f c o n g r u e n c y a n d / o r d i s c r e p a n c y c o u l d be  clearily  i d e n t i f i e d and a n a l y z e d .  underlying  interest  Provus  s t a t e s t h a t an  i n e v a l u a t i o n i s d e r i v e d from a b a s i c d e s i r e  t o p r o v i d e o p t i m a l e d u c a t i o n a l programs and t h a t w i t h i n  this  24  f r a m e w o r k of underlying  seeking  optimal  skepticism  s u g g e s t t h a t we  evaluation describes  will the  on  evaluation 1)  be  and  the  the  are  five  of any  the  Stage I I I : D e l i n e a t i o n Stage IV: S t a g e V:  not  fifth the  the  to  (a  that  further  involving  two  standards that  a c t u a l performance In the  must of  P r o v u s model  there  Program  s t a g e of  and  Interim  t h i s model has  grounds t h a t  Within  of  C o s t E f f e c t i v e n e s s of  c e n t r a l to the  the  Congruence  Testing  Products  the  Program.  been d e l e t e d  i t represents  a phase of  from the  research  that  particular  (1980  curriculum  m a t c h e d t h e homemaker p r a c t i c e d a t a t h a t was case notes with  S t a g e I I I was  being  t h e s i s Stages I through  f o l l o w s : Stage I analyzed  Homemaker T r a i n i n g P r o g r a m  objectives.  is  study.  the  terminal  i n t e r i m o b j e c t i v e ( s ) o f t h e V a n c o u v e r Community  from the c l i e n t  analysis  i s s u e of c o n g r u e n c y and/or d i s c r e p a n c y  p a r a m e t e r s of t h i s  h a v e been u s e d as the  g o e s on  Terminal Products .  pursued w i t h i n t h i s  and  He  an  stages:  Stage I I : Program I n s t i l l a t i o n  on  He  f o u n d , and  i n s t i t u t i o n as  those standards.  S t a g e I : D e s i g n of  The  be  s o l u t i o n process.  2) a c o m p a r i s o n of t h e  i n s t i t u t i o n with  a l w a y s be  assumption that a problem  a d e q u a t e d e f i n i n g of  the  should  present program.  t h a t a s o l u t i o n can  a i d i n the  major s t e p s : followed;  about the  evaluate  discrepancy) exists,  programs t h e r e  the  guide).  goal(s) College  Stage II  originally  curriculum  IV  derived  guide's goals  and  e m p l o y e d t o a n a l y z e assumed  r e l a t i o n s h i p s b e t w e e n - p r o c e s s e s and  the  Specifically,  homemaker s t u d e n t s h o u l d  what c o m p e t e n c i e s t h e  interim  products. be  25  able in  to  practice  this  stage.  product appear  was  i n the  reached  In  to  appeared IV,  specific either  was  For  or  to  met  matched  have final  was  not  noted.  of  It  used  congruence/discrepancy  this  from the  hours  interim product or  being  objective.  that  the  assessed  curriculum guide, noted  of  learning  analysis,  homemaker  s h o u l d be  areas  for  retrieved  the  the  conclusions  terminal goal  for  the  practice  student  c o m b i n a t i o n of  used  examined  which  evaluative  major  of  at  were  minimum number  concerning  the  stage  stage  what  were  the  format  the  example,  category  the  also  IV there  whether  the  curriculum areas  guidelines  Stage  practice  discrepancy  III  student In  as  Stage  Stage  measured.  activities.  sets  within certain  or  only  1980 statistical  a the  analysis  were,  evaluation.  Interviews The focused  final  mode  interviews  representatively was  The  gather  additional  of  homemaker.  Homemaker  form the  of  area  theory  four  field  from the  purpose  of  selected  agency  these  w i t h i n the from the  interview were  and p r a c t i c e  asked of  the  agency  that  supervisors  information related  i n which the  focussed  supervisors  i n s t r u m e n t a t i o n was  supervisors  representatively Vancouver  with  chosen  generated.  the  of  of who  where  the  interviews to  agency  were  of  being  studied  was  questions  that  homemakers  was  role  areas  data  primarily  and  the  used.  were client  the  technique  brief,  to  training  greater is  located.  Specifically,  related  within their  to  the  role,  particular  A  26  agency. the  The  three  r o l e of  there  any  the  questions  w e r e : 1) What do you  homemaker as  she  a r e a of d i s c r e p a n c y  a s s i s t s her  required  t o do  i n the  clients?  home of  and  what she  the c l i e n t ?  p r e s e n t homemaker t r a i n i n g p r o g r a m meet t h e  data from the  that patterns The  patterns  supervisors The  of  interviews  of: r e s p o n s e s p r o v i d e d  and  Is  actually  3) Does n e e d s of  the the  t o the  client?  then content analyzed could  information  be  as  so  studied.  t o how  these b r i e f i n t e r v i e w s  another viewpoint  homemaker t h e o r y  be  the  homemakers w i t h i n t h i s p a r t i c u l a r a g e n c y .  o v e r a l l i n t e n t of  providing  was  r e s p o n s e to. the q u e s t i o n s  viewed the  2)  may  homemakers w i t h i n t h i s a g e n c y i n t h e i r a s s i s t a n c e The  to  b e t w e e n what t h e homemakers. i n  t h i s a g e n c y have been t r a i n e d t o do, be  consider  was  that  from w h i c h t h i s complex a r e a  practice could  be  of  of  seen.  Summary The client and with  methods of  file  theory  data; of  the  presented  and  homemakers s t u d i e d ; and  will  the  will  analyses  a l s o be  homemaker t h a t was  the not  role,  theory,  obtained  The  will  form i n the  additional information  u n d e r s t a n d i n g s of  f iles.  discrepancy  interviews  provide  analysis the  structured  homemaker s u p e r v i s o r s .  in detailed, tabular  f i n d i n g s of the and  were: a s t a t i s t i c a l  a P r o v u s D i s c r e p a n c y a n a l y s i s of  representative  statistical  research  of  practice interviews  r e s u l t s of  the  discussed  and  be  next chapter.  The  presented- i n Chapter about the  VI  supervisors'  and  p r a c t i c e of  the  f r o m an  a n a l y s i s of  the  client  27  Chapter V  RESULTS  Introduct ion This  research  study  concerning  the r o l e ,  t r a i n i n g , and  p r a c t i c e o f t h e homemaker h a s i n v o l v e d t h e n e c e s s i t y o f comparing and a n a l y z i n g within  a v a r i e t y of f a c t o r s that are contained  t h e o v e r a l l c o n c e p t o f t h e homemaker.  Overall,  t h e f i n d i n g s of t h i s  composite p i c t u r e of a s p e c i f i c clients and  i n which there  research  study  present  a  g r o u p o f homemakers and t h e i r  h a s been s i g n i f i c a n t  change.  The r o l e  p r a c t i c e o f t h e homemaker a p p e a r s t o have u n d e r g o n e  observable instance  alterations.  The c u r r i c u l a r  theory  does n o t i n e v e r y  a p p e a r t o m a t c h t h e a c t u a l p r a c t i c e o f t h e homemaker.  However, t h e d a t a  a n a l y s i s d o e s i n d i c a t e more c o n g r u e n c y  than  discrepancy. Specifically, homemaker c l i e n t counterpart. smaller  the s t a t i s t i c a l  i n 1980 a s b e i n g  This c l i e n t  a n a l y s i s reveals the t y p i c a l o l d e r t h a n h e r 1976  o f 1980 i s a l s o r e p r e s e n t a t i v e  family u n i t ; resides p r i m a r i l y i n the c i t y  of a  of V a n c o u v e r ;  i s more a p t t o be r e f e r r e d by L o n g Term C a r e ; h a s a significantly  higher  p e r c e n t a g e of p s y c h i a t r i c and  medical  problems; but r e q u i r e s l e s s a s s i s t a n c e w i t h c h i l d care  i n the  home. In terms of theory  and p r a c t i c e t h e c u r r i c u l u m  homemaker t r a i n i n g p r o g r a m t h a t was c o m p l e t e d by a  of t h e significant  28  percentage primarily  o f homemakers i n t h e a g e n c y s u r v e y e d  discrepancy  occurred  The a r e a s  assisting  r e p l a c i n g Home C a r e n u r s e s  three areas  will  of p r a c t i c e and t h e o r y  i n the c a t e g o r i e s o f : monitoring  of h e a l t h o f t h e c l i e n t ,  V.C.C.  t o be  congruent w i t h the e x c e p t i o n of t h r e e out of the  eleven c a t e g o r i e s tabulated.  and  proved  the c l i e n t  with  the state  medication,  on a t e m p o r a r y b a s i s .  of discrepancy are e x p l i c i t l y excluded  These  from t h e  c u r r i c u l u m o f 1980, and t h e p r e m i s e f o r t h e i r e x c l u s i o n  be a d d r e s s e d  i n the concluding  This chapter  c o n t a i n s a d e t a i l e d p r e s e n t a t i o n of both t h e  statistical  a n a l y s i s of t h e c l i e n t  chapter.  f i l e s a s w e l l a s an  .  e v a l u a t i o n o f t h e t h e o r y and p r a c t i c e o f t h e homemaker. the s t a t i s t i c a l analyses  of d a t a , a guide t o these  the r e a d e r . and  tables t h a t . f o l l o w contain three  separate  t a b l e s h a s been p r o v i d e d f o r  A w r i t t e n summary o f b o t h t h e s t a t i s t i c a l  the e v a l u a t i o n data are i n c l u d e d i n t h i s  Guide t o the S t a t i s t i c a l  Tables  t h e f o l l o w i n g v a r i a b l e s t h a t were o b t a i n e d  homemaker c l i e n t  case  family u n i t , area  notes:  sex of c l i e n t ,  housekeeping;  psychiatric care  1976,1980,  from t h e  a g e , number i n  of r e s i d e n c e , method of r e f e r r a l ;  p r a c t i c e c a t e g o r i e s of t o t a l p e r s o n a l c a r e , t o t a l total  tables  chapter..  C r o s s - t a b u l a t i o n s were done b e t w e e n t h e y e a r s and  Because  combined  child  care,  combined d i a g n o s i s c a t e g o r i e s of t o t a l  problems, t o t a l medical  p r o b l e m s , and t o t a l  child  needs. For each of these v a r i a b l e s t h r e e r e s e a r c h q u e s t i o n s  were  29  t e s t e d t h a t r e q u i r e d s e p a r a t e a n a l y s i s of t h e d a t a . first  i n s t a n c e t h e w r i t e r was  interested  in determining  d e g r e e o f d i f f e r e n c e t h a t m i g h t have e x i s t e d b e t w e e n and 1980 c l i e n t  data.  The  t h a t d i d n o t i n c l u d e L o n g Term C a r e c l i e n t s . of a n a l y s i s t h e w r i t e r compared 1980 non-Long Term C a r e c l i e n t s . t h e q u e s t i o n was  change m i g h t o c c u r . the  the  1976  and  1980  data  In the t h i r d  area  1980 L o n g Term C a r e c l i e n t s  with  In a l l t h r e e a r e a s of r e s e a r c h  t h a t of a s c e r t a i n i n g what p a t t e r n s o f  I n t h e c a s e o f t h e Long Term C a r e  variable,  i n t e n t was a l s o t o d i s c o v e r , i f p o s s i b l e , t h e e x t e n t t o  w h i c h t h e Long Term C a r e c l i e n t m i g h t d i f f e r who  any  second r e s e a r c h area of a n a l y s i s  l o o k e d a t s i m i l a r d i f f e r e n t i a t i o n s between.1976  interest  In the  had n o t been c a t e g o r i z e d a s b e l o n g i n g  from other  clients  t o L o n g Term C a r e .  30  TABLE I C r o s s T a b u l a t i o n of Sex and Y e a r  1 980  1976  1980CLTC) I980(not LTC)  Male  11  (11.1)  19  (19.0)  8  (20.5)  11  (18.0)  Female  87  (87.9)  79  (79.0)  31  (79.5)  48  (78.7)  2 ( 2.0)  1 (1.0)  Couple  Total  99  0 ( 0.0)  39  100  Significance  2 ( 3.3)  61  Tests  2. 1976  v s . 1980  1976  v s . I980(not  LTC)  % = 2.729  ( d f = 2; P = 0.255)  1980(LTC) v s . I 9 8 0 ( n o t  LTC)  X =  ( d f = 2; P = 0.507)  Long t e r m  care  %=  v  2.847  1.358  ( d f = 2; P =  0.241)  31  Table I I C r o s s T a b u l a t i o n o f Age a n d Y e a r  1 980  1976  years  10 - 1 9  1980(LTC) 1 9 8 0 ( n o t LTC)  f  %  f  %  0 (  0.0)  1 (  1.2)  f  %  f  %  .0 (  0.0)  1 (  2.0)  0.0)  8 (16.3)  20 - 29  23 (25.0)  8 (  9.4)  0 (  30 - 39  19 (20.7)  6 (  7.1)  0 (0.0)  6 (12.2)  40 - 49  .3 (  3.3)  4 (  4.7)  0 (0.0)  4 (  8.2)  50 - 59  8 .( 8,7)  7 (  8.2)  3 (  4 (  8.2)  60 - 69  9 (  9.8)  1 7 (18.5)  70 - 79 80 - 89  9 (  9.8)  90 - 99  4 (  4.3)  92  Total  8.3)  20 ( 2 3 . 5 )  10 (27.8)  10 (20.4)  16 ( 1 8 . 8 )  6 (16.7)  10 (20.4)  22 ( 2 5 . 9 )  .1 7 (47.2)  5 (10.2)  1 (  1.2)  85  Significance  0 (  36  0.0)  . 1(  2.0)  49  Tests  1976  v s . 1980  K e n d a l l ' s Tau C =  0.281;(P = 0.001 ) .  1976  v s . I 9 8 0 ( n o t LTC) K e n d a l l ' s Tau C =  0.077;(P = 0.414) .  1 9 8 0 ( L T C ) v s . I 9 8 0 ( n o t LTC) K e n d a l l ' s T a u C = - 0 . 5 1 2 ; ( P = 0.000) .  32  Table I I I C r o s s T a b u l a t i o n o f Number i n F a m i l y U n i t a n d Y e a r  1976  no.  1980  %  f  f  1980(LTC) I 9 8 0 ( n o t LTC)  %  f  %  f  1  1  41  (41.4)  46 ( 4 6 . 5 )  26 ( 6 8 . 4 )  20 (32.8)  2  1 5 (15.2)  29 ( 2 9 . 3 )  1 1 (28.9)  18 ( 2 9 . 5 )  3  22 (22.2)  10 (10.1)  1 (  2.6)  9 (14.8)  4  7 (  7.1)  8 (  8.1)  0 (  o.'o)  8 (13.1)  5  6 C 6.1)  2 (  2.0)  0 (  0.0)  2 (  6  7 (  7.1)  1 (  1.0)  0 (  0.0)  1 ( 1 .6)  7  1 (  1.0)  3 (  3.0)  0 (  0.0)  3 (  99  Total  99  Significance  38  3.3)  4.9)  61  Tests  K e n d a l l ' s Tau C = - 0 . 1 3 5 ; ( P = 0.087) .  1976  v s . 1980  1976  v s . I 9 8 0 ( n o t LTC) K e n d a l l ' s Tau C =  0 . 0 2 6 ; ( P = 0.777) .  1980(LTC) v s . I 9 8 0 ( n o t LTC) K e n d a l l ' s Tau C =  0 . 4 3 9 ; ( P = 0.000) .  33  Table IV C r o s s T a b u l a t i o n of A r e a of R e s i d e n c e and Year  A r e a Where  1980  1976  a Code  f  I  Living  .f  1980(LTC) I 9 8 0 ( n o t LTC)  1  f  %  •f  I 8.5)  1  4 (4.1)  8 (  8.2)  '3 (  7.9)  5 (  2  1 0 (10.2)  2 (  2.1)  1 (  2.6)  1 (•' 1.7)  3  4 ( 4.1  2 (  2.1)  0 (  0.0)  2 (  3.4)  4  4 (  4.1)  6 (  6.2)  2 (  5.3)  4 (  6.8)  5  0 (  0.0)  6 (  6.2)  1 '(  2.6)  5 (  8.5)  6  2 (  2.0)  1 (  1.0)  0 (  0.0)  1 (  1.7)  7  2 (  2.0)  3 (  3.1)  1 (  2.6)  2 (  3.4)  8  7 (  7.1)  7 (  7.2)  2 (  5.3)  5 (  8.5)  9  2 (  2.0)  3 (  3.1)  1 (  2.6)  2 (  3.4)  10  2 (  2.0)  2 (  2.1)  1 (  2.6)  1 (  1.7)  1 1  1 1 (11.2)  :  1 6 (16.5)  9 (23.7)  7 (11.9)  4 (10.5)  1 (  1.7)  12  3 (  3.1)  5 (  13  2 (  2.0)  2 (2.1)  1 (  2.6)  1 (  1.7)  V4  3 (  3.1)  2 (  2.1)  0 (  0.0)  2 (  3.4)  15  2 (  2.0)  2 (  2.1)  1 (  2.6)  1 (  1.7)  16  2 (  2.0)  0 (  0.0)  0 (  0.0)  0 (  0.0)  17  0 (  0.0)  1 (  1.0)  0 (  0.0)  1 (  1.7)  18  8 (  8.2)  5 (  5.2)  4 (10.5)  1 (  1.7)  5.2)  34  Table IV Cross T a b u l a t i o n of Area  (Continued)  of R e s i d e n c e  1976  Area  1980  and Y e a r ( c o n t i n u e d )  1980(LTC)  1 9 8 0 ( n o t LTC)  Code  19  1 (  1.0)  3 ( 3.1 )•  1 ( 2.6)  2 (  3.4)  20  5 (  5.1)  3 (  3.1)  2 ( 5.3)  1 (  1.7)  21  3 (  3.1)  2 ( 2. i )  0 ( 0.0)  2 •(• 3.4)  22  0 (  0.0)  1 (  0 ( 0.0)  1 (  1.0)  1 3 (13.4)  3. •( 7.9)  1.7)  1 0 (16.9)  23  10 • ( 10.2)  24  1 0 (10.2)  1 (  1.0)  1 ( 2.6)  0 (  0.0)  25  1 (1.0)  1 (  1.0)  0 ( 0.0)  1 (  1.7)  Total  98  97  38  Significance  59  Tests  1976  v s . 1980  X=  1976  v s . I 9 8 0 ( n o t LTC)  V = 31.82 ( d f = 24; P = 0 . 1 3 2 ) .  1980(LTC) v s . I 9 8 0 ( n o t LTC)  21.53 ( d f = 23; P = 0 . 5 4 9 ) .  30.24 ( d f = 24; P = 0 . 1 7 7 ) .  35  T a b l e IV  (Continued)  Biodemographic Data  A r e a Where L i v i n g  (Continued)  Hastings/Sunrise  1  14  2 = Renfrew/Collingwood 3 = Killarney  Oakridge  1 5 = Marpole .  1 6 = Shaughnessy  4 .= G r a n d v i e w / W o o d l a n d s  17 = K e r r i s d a l e  5 = Kensington/Cedar  18 = K i t s i l a n o  Victoria/Fraserview  6  Cottage  1 9 = Arbutus  7 = Strathcona  20 = D u n b a r / S o u t h l a n d s  8 = Mt.  21 = West P t . G r e y  Pleasant  9 = Riley  Park  22 = U n i v . End.  1 0 = Sunset  23 = B u r n a b y  11 = West  24 = R i c h m o n d  End  1 2 = Fairview 1  Ridge  3  =  South  Cambie  25  Lands  N. Vanc./W. V a n e .  36  Table Cross Tabulation  V  of Method  Method  of  of R e f e r r a l  Referral  1976  (LTC)  Client/Relative  of  Medical Social  0 .( Client  Staff S e r v i c e Agency  Total  1980  %  f  Long Term C a r e  and Y e a r  f  o.,0)  39  I980(not  I  (39. .8)  3 (  23  (23. .5).  1 9 (21 .. 1 )  36  (36. .7)  29  90  Significance  %  f  (43. ,3)  39  98  LTC)  3.,3) .. ••' 3.(  (32. .2)  5.,9)  . 1 9 (37. ,3) 29  (56. .9)  51  Tests  1976  v s . 1980  % = 70.78  ( d f = 3; P = 0.000).  1976  v s . I 9 8 0 ( n o t LTC)  y^=  ( d f = 2; P = 0.000).  19.06  37  TABLE V I . C r o s s T a b u l a t i o n o f Combined P e r s o n a l C a r e P r a c t i c e a n d Y e a r  Client  Personal  1980  1 976  received  1980CLTC) I 9 8 0 ( n o t  LTC)  Care  No  87 ( 8 7 . 0 )  58 (58.0)  17 (43.6)  41  (67.2)  Yes  13 ( 1 3 . 0 )  42 (42.0)  22 (56.4)  20  (32.8)  39  61  1 00  Total  1 00  Significance  1976  vs.  1980  1976  vs.  I980(not  LTC)  >=  1980(LTC)  vs.  I980(not  LTC)  Tests  7-= 21.09 ( d f  = 1  P  0.000)  (df  = 1  P  0.003)  yT= 5.450 ( d f  = 1  P  0.020)  9.103  38  Table V I I C r o s s T a b u l a t i o n of Combined C h i l d Care P r a c t i c e  Client Child  received  1976  and Year  1980  1980(LTC)  1 9 8 0 ( n o t LTC)  (81.0)  39 ( 1 0 0 . )  42  (68.9)  0 ( 0.0)  19  (31.1)  Care  No  . 55 ( 5 5 . 0 )  Yes  Total  81  19 ( 1 9 . 0 ) :  45 ( 4 5 . 0 )  100  100  39  Significance  61 .  Tests  %=  15.53 (df = 1; P = 0.000) .  v s . I 9 8 0 ( n o t LTC)  j?=  3.036 (df = 1; P = 0.082) .  v s . I 9 8 0 ( n o t LTC)  X*=  15.00 (df = 1; P = 0.000) .  1976  v s . 1980  1976 1980(LTC)  •  39  Table Cross Tabulation  Client  VIII  of Combined H o u s e k e e p i n g P r a c t i c e and Year  1 976  received  1980  1980(LTC) I 9 8 0 ( n o t LTC)  Housekeeping  7(7.0)  No Yes  Total  93  (93.0)  3(3.0)  3(7.7)  97 ( 9 7 . 0 )  36 (92.3)  61  39  61  1 00  1 00  Significance  0(0.0) (100.)  Tests  1976  v s . 1980  1.684 ( d f = 1  P  0. 194)  1976  v s . I 9 8 0 ( n o t LTC)  4.464 ( d f = 1  P  0.035)  1 9 8 0 ( L T C ) v s . I 9 8 0 ( n o t LTC)  4.837 ( d f = 1  P  0.028)  40  TABLE I X C r o s s T a b u l a t i o n o f Combined P s y c h i a t r i c  Client  1976  1980  92 (92.0)  80 ( 8 0 . 0 )  36 (92.3)  8(8.0)  20 (20.0)  3 ( 7.7)  indicated  Psychiatric  Problems and Year  1980(LTC) 1 9 8 0 ( n o t LTC)  Problems  No Yes  1 00  Total  1 00  39  Significance  44  (72.1)  17 (27.9)  61  Tests  1 976  vs.  1980  %=  1 976  vs.  I 9 8 0 ( n o t LTC)  1 = 11.40 ( d f = 1; P = 0.001 ) .  1980(LTC) v s . I 9 8 0 ( n o t LTC)  5.980 ( d f = 1 ; P = 0 . 0 1 5 ) .  ?C= 6.053 ( d f = 1; P = 0 . 0 1 4 ) .  41  Table X C r o s s T a b u l a t i o n o f Combined M e d i c a l P r o b l e m s a n d Y e a r  Client Medical  1980  1 976  indicated  1980(LTC) I 9 8 0 ( n o t LTC)  Problems  No  35  (35.0)  20 ( 2 0 . 0 )  2 ( 5.1)  Yes  65.(65.0)  80 ( 8 0 . 0 )  37 ( 9 4 . 9 )  43  39  61  Total  1 00  1 00  Significance  1,8 (29.5) (70.5)  Tests  1976  v s . 1980  X=  5.643 (df = 1; P = 0.018)  1976  v s . I 9 8 0 ( n o t LTC)  V=  0.517  (df = 1; P = 0.472)  8.838  (df = 1; P = 0.003)  1980(LTC) v s . I 9 8 0 ( n o t LTC)  42  Table XI C r o s s T a b u l a t i o n of C h i l d Care Problems and Year  Client  1976  indicated  1980  1980(LTC) 1 9 8 0 ( n o t LTC)  (94.0)  39  C h i l d Care Problems  No  72  (72.0)  Yes  28  (28.0)  Total  94  6 (6.0)  1 00  1 00  X=  0 ( 0.0)  39  Significance  (100.)  55  (90.2)  6 ( 9.8)  61  Tests  1976  v s . 1980  17.15 ( d f = 1; P = 0.000)  1976  v s . I 9 8 0 ( n o t LTC)  7.504  ( d f = 1; P = 0.006)  1980 (LTC)- v s . I 9 8 0 ( n o t LTC)  )C= 4.081  ( d f = 1; P = 0.043)  43  Summary o f t h e S t a t i s t i c a l The  statistical  Data  t a b l e s were c o n s t r u c t e d t o r e f l e c t t h e  f o l l o w i n g : biodemographic p r o f i l e s of t y p i c a l c l i e n t s ; the reasons they  r e c e i v e d homemaker s e r v i c e ; a n d what k i n d s o f  homemaker a s s i s t a n c e were p r o v i d e d The studied  t o these  homemaker p r a c t i c e a n d c l i e n t i n both  clients.  d i a g n o s i s c a t e g o r i e s were  i n d i v i d u a l and combined data a n a l y s i s .  i n d i v i d u a l c a t e g o r i e s of p o s t - p a r t u m d e p r e s s i o n , problem and  (undifferentiated),  s u i c i d a l throught  the c a t e g o r y  of t o t a l  senility,  disturbance  were a l l c o m b i n e d t o c r e a t e  psychiatric  diagnosis.  illness,  arthritis,  a t home w i t h  of t o t a l medical  were a l l c o m b i n e d t o c r e a t e  diagnoses.  c a t e g o r i e s of s i c k c h i l d w i t h parent and  The i n d i v i d u a l  diabetes, cardiovascular disease,  l u n g d i s e a s e , and cancer  the category  The i n d i v i d u a l  working,  p a r e n t l e s s home,  new baby were c o m b i n e d t o c r e a t e t h e t o t a l  diagnostic  psychiatric  stress, alcoholism, schizophrenia,  c a t e g o r i e s of p h y s i c a l handicap, undifferentiated  The  c h i l d care  needs  category.  In t h e second area of c a t e g o r y  groupings,  individual  c a t e g o r i e s of u n d i f f e r e n t i a t e d p e r s o n a l c a r e , ambulate, change d r e s s i n g s , help d r e s s , help bathe, medication, category both  monitor  health, assist  with  a n d r e p l a c e Home C a r e n u r s e became t h e t o t a l  of p e r s o n a l care p r a c t i c e .  Care f o r c h i l d r e n e x i s t e d  a s an i n d i v i d u a l a s w e l l a s a t o t a l  I n d i v i d u a l c a t e g o r i e s o f home c a r e laundry, prepare p r a c t i c e category  p r a c t i c e category.  ( u n d i f f e r e n t i a t e d ) , c l e a n , do  m e a l s , a n d s h o p were c o m b i n e d f o r t h e t o t a l of housekeeping p r a c t i c e .  c a t e g o r i e s were t a b u l a t e d f o r t h e y e a r s  I n d i v i d u a l sub-  1976 a n d 1980. The  44  c o m b i n e d c a t e g o r i e s were t a b u l a t e d 1976  vs.  1980 ( e x c l u d i n g a l l LTC c l i e n t s ) ;  clients) vs. the  f o r 1976 v s .  1980 (non-LTC c l i e n t s ) .  individual categories  1980  a n d 1980 (LTC  The d e c i s i o n t o c o m b i n e  i n t o combined, t a b u l a t e d  categories  was b a s e d on t h e f i n d i n g t h a t most o f t h e i n d i v i d u a l were n o t s t a t i s t i c a l l y  significant,  (total);  categories  a n d i n some c a s e s were  overlapping.  Individual Categories The  of P r a c t i c e  individual categories  of t h e o v e r a l l p r a c t i c e  displayed the following trends. increase  in particular  assistance home c a r e shopping.  Areas i n which there  s e r v i c e s being  Decreases occurred  care;  1980  c l i e n t ' s health status  In t h e a r e a  precursor  signs);  Diagnosis diagnosis,  t o the problems the c l i e n t  Increases  diagnostic categories  to  and b a t h e .  the area  experienced  t o n e e d i n g homemaker a s s i s t a n c e , t h e f o l l o w i n g  were o b s e r v e d .  the  (e.g. g i v i n g prepoured medication  of i n d i v i d u a l c l i e n t  refers specifically  were c r e a t e d i n  ( e . g . noted changes i n v i t a l  of  with  and  These were: m o n i t o r i n g  h e l p i n g t o ambulate; dress;  Individual Categories  laundry;  New c a t e g o r i e s  i n 1976.  a s s i s t i n g with medications the c l i e n t ) ;  m e a l s ; and  i n the areas o f : a s s i s t i n g  (undifferentiated).  that d i d not e x i s t  were:  r e p l a c i n g the  cleaning; preparing  d r e s s i n g changes; c a r i n g f o r c h i l d r e n ; doing housekeeping  was an  r e c e i v e d by c l i e n t s  with u n d i f f e r e n t i a t e d personal nurse t e m p o r a r i l y ;  category  occurred  that as a trends  i n 1980 w i t h i n t h e c l i e n t  o f : u n d i f f e r e n t i a t e d p s y c h i a t r i c problems;  45  a l c o h o l i s m ; p h y s i c a l handicap; at home with undiagnosed i l l n e s s ; d i a b e t i c c o n d i t i o n ; c a r d i o v a s c u l a r d i s e a s e ; and cancer. Decreases occurred senility;  i n the areas o f : s t r e s s syndrome; a r t h r i t i s ;  lung d i s e a s e ;  s i c k c h i l d with parent  working;  p a r e n t l e s s home; and new baby. The trends  i n d i v i d u a l c a t e g o r i e s , while d i s p l a y i n g i n t e r e s t i n g  i n p r a c t i c e and d i a g n o s i s , cannot be construed  statistically  significant.  as being  Given the d i v e r s e spread of  c a t e g o r i e s , a d e c i s i o n was made to combine the i n d i v i d u a l subsets accurate  of d i a g n o s i s arid p r a c t i c e i n t o the more s t a t i s t i c a l l y groupings o f : t o t a l p e r s o n a l  care p r a c t i c e , t o t a l  child  care p r a c t i c e , t o t a l housekeeping p r a c t i c e , t o t a l p s y c h i a t r i c diagnosis, diagnosis.  t o t a l medical d i a g n o s i s , and t o t a l c h i l d care needs These s p e c i f i c ,  i n d i v i d u a l c a t e g o r i e s do not appear  as such w i t h i n the t a b u l a r form of the preceding tables.  statistical  46  Q u a n t i t a t i v e Statements  T a b l e I - Sex The  of  C o n c e r n i n g T a b l e s I - XI  Client  homemaker c l i e n t s  p r e d o m i n a t e l y female  in this  s t u d y were shown t o  i n b o t h y e a r s ; 87.9  % i n 1976;  be  79.0  % in  1980.  T a b l e I I - Age The  of  client  Client  of  1980  also  i n c r e a s e d i n age  increase occurring  i n t h o s e 80-90 y e a r s : 9.8%  t o 25.9%  47.2%  years.  i n 1980. T h e r e was  u n d e r t h e age  of  o f t h e LTC  with a  significant  i n 1976  compared  c l i e n t s were a g e d 80 -  a corresponding decrease  i n 1980  of  90  clients  fourty.  T a b l e I I I - Number i n F a m i l y U n i t The  client  of  1980  c l i e n t s were e s p e c i a l l y u n i t s , w i t h 68.4%  living  Table IV - Area of The  represented a smaller family unit. r e p r e s e n t a t i v e of d e c r e a s e d alone.  m a j o r i t y of c l i e n t s By  1980  residency  i n t h e West End;  16.5%  1980.  T a b l e V - Method of It  family  Residence  Vancouver r e s i d e n t s .  in  LTC  i n b o t h y e a r s were C i t y t h e r e was  increasing  a rise  from  of  in client  11.2%  i n 1976  to  Referral  i s i m p o r t a n t t o n o t e t h a t t h e L o n g Term C a r e  d i v i s i o n of t h e M i n i s t r y  of H e a l t h d i d not e x i s t  (LTC)  i n 1976.  By  47  1980,  following  of a l l c l i e n t s LTC. or  the creation  o f t h i s LTC d i v i s i o n  i n 1978, 4 3 . 3 %  t o t h i s homemaker a g e n c y were b e i n g r e f e r r e d by  I n 1976, 3 9 . 8 % o f a l l c l i e n t s  the c l i e n t ' s  relative;  were r e f e r r e d by t h e c l i e n t  by 1980 t h i s  r e f e r r a l mode h a d  d e c r e a s e d t o o n l y 3.3%.  T a b l e s VI t h r o u g h V I I I  - Combined P r a c t i c e  When t h e a b o v e i n d i v i d u a l c a t e g o r i e s  Categories were c o m b i n e d f o r  o v e r a l l a n a l y s i s , the f o l l o w i n g p i c t u r e  o f homemaker  appeared.  increased  Total  personal care practice  1976 t o 4 2 . 0 % i n 1980.  I n 1980.56.4% o f t h o s e  personal care assistance  were.LTC c l i e n t s .  practice  f r o m 13.0% i n  receiving  Total  child  care  p r a c t i c e d e c r e a s e d f r o m 4 5 . 0 % i n 1976 t o 19.0% i n 1980, w i t h no LTC c l i e n t s displayed  r e c e i v i n g "this s e r v i c e .  no s i g n i f i c a n t  differentiation  clients  i n 1976 r e c e i v i n g h o u s e k e e p i n g a s s i s t a n c e ,  clients;  received  i n e i t h e r year, with  housekeeping s e r v i c e  100% o f t h e non-LTC c l i e n t s  practice  i n the percentage of  receiving  92.3% c l i e n t s  service  housekeeping  clients  1980.  this  Total  had h e l p w i t h  93.0% of t h e 97.0% i n were LTC their  housework.  T a b l e s I X t h r o u g h XI - Combined D i a g n o s i s  Categories  The c o m b i n e d c a t e g o r y o f d i a g n o s e s p r e s e n t s t h e f o l l o w i n g information  a b o u t t h e homemaker c l i e n t .  diagnoses increased 1980.  Total  f r o m 8.0% o f t h e c l i e n t s  psychiatric  i n 1976 t o 2 0 . 0 % i n  I n 1980 t h e r e were 2 7 . 9 % o f t h e non-LTC c l i e n t s  c a t e g o r y , a s o p p o s e d t o 7.7% i n t h e same y e a r . diagnoses increased  Total  in this medical  f r o m 6 5 . 0 % i n 1976 t o 8 0 . 0 % i n 1980. A  48  higher percentage problem,  of LTC  w i t h 94.9%  c l i e n t s had  of a l l LTC  d i a g n o s i s a s o p p o s e d t o 70.5%  The  clients  having a medical  of t h e non-LTC c l i e n t s .  c h i l d care problems a decrease clients  a medical diagnosis  o c c u r r e d w i t h 28.0%  i n t h i s c a t e g o r y , w h i l e 6.0%  had  In  of  total  1976  t h i s problem  in  1980.  P r o v u s D i s c r e p a n c y M o d e l A p p l i e d t o Homemakers The  Provus D i s c r e p a n c y Model  (see Table X I I ) p r e s e n t s a .  d e t a i l e d , m u l t i - s t a g e a n a l y s i s of t h e l e v e l of c o n g r u e n c y d i s c r e p a n c y t h a t appears  to exist  t h i s a g e n c y p r a c t i c e d and homemakers had  p r o g r a m t h a t was s e r i e s of s e v e n  used  b e t w e e n what t h e homemaker i n  t h e t h e o r y t h a t a m a j o r i t y of  been t a u g h t .  The  (Protection  these  c u r r i c u l u m of t h e V.C.C.  i n the d i s c r e p a n c y e v a l u a t i o n c o n t a i n s a  t r a c k s of, t e a c h i n g and  student a c t i v i t i e s .  a r e : T r a c k A ( O r i e n t a t i o n t o Employment M a r k e t ) , T r a c k (Orientation  i n t h e Home), T r a c k D Track F  ( N u t r i t i o n ) , Track  (Communications),  and  C  E  Track  They  B  to Occupational Role and.Function), Track  and D e v e l o p m e n t ) ,  or  (Growth G  (Health). In p r e p a r i n g the data phase, the t o t a l comparative The  writer's  for this discrepancy evaluation  c u r r i c u l u m of t h e p r o g r a m was  purposes  w i t h the s t a t i s t i c a l  i n t e n t was  to determine  analyzed for  practice categories.  where and  t o what e x t e n t a  p a r t i c u l a r homemaker p r a c t i c e a p p e a r e d  t o have been  within  1980  t h e homemaker t r a i n i n g p r o g r a m ,  c a t e g o r i e s i t was  taught  format.  p o s s i b l e to a s c e r t a i n these  In a l l  curricular  d e t a i l s , w i t h t h e e x c e p t i o n o f t h e Homemaker P r a c t i c e  Category  49  7.0:  Care f o r C h i l d r e n , Stage  to hours  of t e a c h i n g / a c t i v i t y  practice alone. area  111, s u b s e t , s t u d e n t g u i d e l i n e s as specifically  This category presented a uniquely  of t e a c h i n g and a c t i v i t y  t h i s practice category.  The r e a s o n  from  care t r a i n i n g  the fact  that c h i l d  t r a c k s o f C, D, E, F, a n d G.  t h a t c o u l d be r e l a t e d t o  for this difficulty  arose  i s subsumed u n d e r t h e  Subsequently,  t h i s one s u b s e t o f  I I I d o e s n o t i n d i c a t e t h e amount o f a c t u a l  t e a c h i n g / p r a c t i c e time a l l o t e d homemaker c o u r s e . Stage  difficult  f o r r e s e a r c h i n g a l l t h e p o s s i b l e t r a c k s and t h e i r sub  specialities  Stage  related to this  i n the c u r r i c u l u m o u t l i n e  I t i s , however, obvious  t h a t Stages  f o r the  I through  IV i n d i c a t e e x t e n s i v e congruence i n t h i s area of p r a c t i c e . The  overall  r e s u l t s of the Provus  Discrepency  i n d i c a t e t h a t a s i g n i f i c a n t degree of congruence  Model  occurred  b e t w e e n t h e t h e o r y a n d t h e p r a c t i c e o f t h e homemaker g r o u p . a r e a s of d i s c r e p a n c y , as noted apparent  reasons  curriculum w i l l chapter.  for their  within  the Provus  model, and t h e  e x c l u s i o n f r o m t h e V.C.C.  be a d d r e s s e d  in detail  The  homemaker  i n the concluding  50  Table XII Homemaker  Practice  Category  1.0 A m b u l a t e  Client  Stage I Terminal  Goal:  T r a c k G. " A s s i s t c h i l d r e n and a d u l t s to m a i n t a i n t h e i r a c t i v i t i e s of daily living."  Interim  Objectives:  G.  G.  G.  I . "Demonstrate a c c e p t a n c e of t h e homemaker's r o l e i n . r e l a t i o n t o s u p e r v i s i n g h e a l t h . p e r s o n n e l and responsibilities appropriate to t h e homemakers i n t h e d e l i v e r y o f health care." I I . " A s s i s t c h i l d r e n and ambulatory adults with a s t a b i l i z e d c a r e p l a n t o meet t h e i r needs f o r p e r s o n a l c a r e under t h e p r e s c r i p t i o n and s u p e r v i s i o n of the h e a l t h c a r e team." I I . 3.0 " A s s i s t i n f a n t s , c h i l d r e n and a d u l t s t o m a i n t a i n t h e l e v e l of e x e r c i s e a n d a c t i v i t y p r e s c r i b e d t o meet i n d i v i d u a l needs." •  Stage I I Homemaker p r a c t i c e i n d i c a t e s 5% o f t h e c l i e n t s i n 1980 r e c e i v e d service. V.C.C. Curriculum indicates Terminal G o a l G. and I n t e r i m O b j e c t i v e s G.I., G . I I . , G.II.3.0 r e l a t e d t o P r a c t i c e C a t e g o r y 1.0. Stage I I I V.C.C. Curriculum i n d i c a t e s student w i l l be a b l e t o assist client in the f o l l o w i n g a r e a s (examples g i v e n ) :  " T r a n s f e r r i n g a c l i e n t f r o m t h e bed t o various s i t t i n g positions i n a chair, wheelchair, t o i l e t , tub, or c h a i r . " " A s s i s t a c l i e n t t o walk w i t h mechanical a i d s , such a s , canes, crutches, walkers, or without aids." S t u d e n t s G u i d e l i n e s i n d i c a t e a minimum of 60 m i n u t e s i n d e p e n d e n t a c t i v i t y , 30 m i n u t e s w h o l e g r o u p a c t i v i t y , a n d a home a s s i g n m e n t related to ambulation.  Stage  IV Data i n d i c a t e s . congruence i n practice category.  52  Table XII (continued) Homemaker P r a c t i c e C a t e g o r y 2.0 H e l p D r e s s  Stage I Terminal  Interim  Goal:  Objectives:  T r a c k G. " A s s i s t c h i l d r e n and a d u l t s to m a i n t a i n t h e i r a c t i v i t i e s of daily living." G.  G.  G.  I . "Demonstrate a c c e p t a n c e of t h e homemaker's r o l e i n r e l a t i o n t o s u p e r v i s i n g h e a l t h p e r s o n n e l and r e s p o n s i b i l i t i e s appropriate to t h e homemakers i n t h e d e l i v e r y o f health care." I I . " A s s i s t c h i l d r e n and ambulatory a d u l t s with a s t a b i l i z e d c a r e p l a n t o meet t h e i r needs f o r p e r s o n a l care under t h e p r e s c r i p t i o n and s u p e r v i s i o n of t h e h e a l t h care team." I I . 1.2 " P r o v i d e t h e a s s i s t a n c e r e q u i r e d by t h e i n f a n t , t h e c h i l d , the temporarily i n c a p i c i t a t e d a d u l t and t h e e l d e r l y p e r s o n who h a s m o d e r a t e l i m i t a t i o n s i n c a r r y i n g out personal hygiene."  Stage I I Homemaker p r a c t i c e d a t a i n d i c a t e s 4% of t h e c l i e n t s i n 1980 r e c e i v e d service. V.C.C. C u r r i c u l u m i n d i c a t e s t e r m i n a l g o a l G.; i n t e r i m o b j e c t i v e s G . I . , G.II. , G.II.1.2 r e l a t e d t o p r a c t i c e c a t e g o r y 2.0. Stage I I I V.C.C. Curriculum i n d i c a t e s student w i l l be a b l e t o assist client in the f o l l o w i n g areas (examples g i v e n ) :  " P r o v i d i n g n e a t , c l e a n c l o t h i n g and bedding." S t u d e n t s G u i d e l i n e s i n d i c a t e a minimum of 60 m i n u t e s g r o u p a c t i v i t y , i n c l u d i n g f i l m s t r i p and r e s o u r c e sheet f o r students r e l a t e d t o personal care i n long-term illnesses.  Stage IV Data i n d i c a t e s congruence i n p r a c t i c e category.  54  Table XII (continued) Homemaker P r a c t i c e C a t e g o r y 3.0 H e l p B a t h e  Stage I Terminal goal:  T r a c k G. " A s s i s t c h i l d r e n and a d u l t s to maintain t h e i r a c t i v i t i e s of daily living."  Interim  G.  Objectives:  G.  G.  I . "Demonstrate acceptance of t h e homemaker's r o l e i n r e l a t i o n t o s u p e r v i s i n g h e a l t h p e r s o n n e l and r e s p o n s i b i l i t i e s appropriate to t h e homemakers i n t h e d e l i v e r y o f health care." I I . " A s s i s t c h i l d r e n and ambulatory adults with a s t a b i l i z e d c a r e p l a n t o meet t h e i r needs f o r p e r s o n a l c a r e under t h e p r e s c r i p t i o n and s u p e r v i s i o n of t h e h e a l t h c a r e team." I I . 1.2.1 " P r o v i d e t h e a s s i s t a n c e r e q u i r e d by t h e i n f a n t , t h e c h i l d , the temporarily i n c a p i c i t a t e d a d u l t and t h e e l d e r l y p e r s o n who h a s m o d e r a t e l i m i t a t i o n s i n m e e t i n g needs f o r b a t h i n g and eye c a r e . "  Stage I I Homemaker p r a c t i c e d a t a i n d i c a t e s 19% of t h e c l i e n t s i n 1980 r e c e i v e d service. V.C.C. C u r r i c u l u m i n d i c a t e s t e r m i n a l g o a l G., i n t e r i m o b j e c t i v e s G . I . , G . I I . , G.II.1.2.1 r e l a t e d t o p r a c t i c e c a t e g o r y 3.0. Stage I I I V.C.C. Curriculum i n d i c a t e s student w i l l be a b l e t o assist client in the f o l l o w i n g areas (examples g i v e n ) :  " P r o v i d i n g a s s i s t a n c e w i t h bed b a t h s , baby b a t h s , s h o w e r s a n d t u b baths." S t u d e n t G u i d e l i n e s i n d i c a t e a minimum of 4 h o u r s g r o u p / i n d i v i d u a l a c t i v i t i e s , p o s t - t e s t i n g ; use o f f i l m s t r i p and r e s o u r c e s h e e t s related to bathing assistance.  Stage  IV Data i n d i c a t e s congruence i n practice category.  56  Table X I I (continued) Homemaker P r a c t i c e C a t e g o r y  4.0 M o n i t o r  Health  State  Stage I Terminal Goal: Interim Objective:  .  No t e r m i n a l g o a l / i n t e r i m related to practice  objective category.  Stage I I Homemaker p r a c t i c e d a t a i n d i c a t e s 7% of t h e c l i e n t s i n 1980 r e c e i v e d service. V.C.C. C u r r i c u l u m i n d i c a t e s no terminal goal/interim objective related to practice catagory. Stage I I I V.C.C. Curriculum i n d i c a t e s no interim products related to practice. Stage IV  .  Data i n d i c a t e s l a c k of c o n g r u e n c e i n practice category.  57  Table X I I (continued) Homemaker P r a c t i c e C a t e g o r y  5.0 A s s i s t W i t h  Medication  Stage I Terminal Goal: Interim Objective:  No t e r m i n a l g o a l / i n t e r i m related to practice  objective category.  Stage I I Homemaker p r a c t i c e d a t a i n d i c a t e s 2% of t h e c l i e n t s i n 1980 r e c e i v e d service. V.C.C. C u r r i c u l u m i n d i c a t e s no terminal goal/interim objective related to practice catagory. Stage I I I V.C.C. Curriculum i n d i c a t e s no interim products related to practice. Stage  IV Data i n d i c a t e s lack of c o n g r u e n c e i n practice category.  58  Table X I I (continued) Homemaker P r a c t i c e C a t e g o r y  6.0 R e p l a c e  Homecare N u r s e  Temporarily  Stage I Terminal Goal: Interim Objective:  No t e r m i n a l g o a l / i n t e r i m related to practice  objective category.  Stage I I Homemaker p r a c t i c e d a t a i n d i c a t e s 4% of t h e c l i e n t s i n 1980 r e c e i v e d service. V.C.C. C u r r i c u l u m i n d i c a t e s no terminal goal/interim objective related to practice catagory. Stage  III . V.C.C. Curriculum i n d i c a t e s no interim products related to practice.  Stage  IV Data i n d i c a t e s lack of c o n g r u e n c e i n practice category.  59  Table XII (continued) Homemaker P r a c t i c e C a t e g o r y 7.0 C a r e f o r C h i l d r e n  Stage I Terminal Goal:  T r a c k E. "Work w i t h c h i l d r e n a n d a d u l t s a t v a r i o u s s t a t e s of g r o w t h and d e v e l o p m e n t . " T r a c k G. ' - " A s s i s t ' c h i l d r e n , a n d a d u l t s t o m a i n t a i n t h e i r a c t i v i t i e s of daily living."  Interim Objectives:  E.  E.  G.  G.  G. G.  G.  G.  I . " U n d e r s t a n d t h e common c u l t u r a l , e m o t i o n a l , and b i o l o g i c a l n e e d s o f an i n d i v i d u a l a r i s i n g f r o m h i s age ( s t a g e o f growth and development), l i f e s t y l e and f a m i l y s i t u a t i o n . " I I . "Demonstrate a h e l p i n g r e s p o n s e t o g i v e n i n d i v i d u a l s and families consistent with their b a s i c human n e e d s a n d s p e c i a l needs f o r growth and development." I . "Demonstrate a c c e p t a n c e of t h e homemaker's r o l e i n r e l a t i o n t o s u p e r v i s i n g h e a l t h p e r s o n n e l and r e s p o n s i b i l i t i e s appropriate to t h e homemakers i n t h e d e l i v e r y o f health care." I I . " A s s i s t c h i l d r e n and ambulatory adults with a s t a b i l i z e d c a r e p l a n t o meet t h e i r needs f o r p e r s o n a l c a r e under t h e p r e s c r i p t i o n and s u p e r v i s i o n of the h e a l t h care team. " I I . 1.0 " A s s i s t i n m a i n t a i n i n g h e a l t h y f u n c t i o n of t h e s k i n and mucuous membranes ..." I I . 2.0 " A s s i s t i n p r o v i d i n g c o n d i t i o n s which promote r e s t and s l e e p f o r i n f a n t s , c h i l d r e n and adults." I I . 3.0 " A s s i s t i n f a n t s , c h i l d r e n and a d u l t s t o m a i n t a i n t h e l e v e l of e x e r c i s e and a c t i v i t y p r e s c r i b e d t o meet i n d i v i d u a l needs." I I . 4.0 " A s s i s t an i n d i v i d u a l t o meet h i s n o r m a l n e e d s f o r e l i m i n a t i o n from bowel, b l a d d e r , s k i n and l u n g s .  60  G. G.  G.  I I . 5.0 " A s s i s t i n f a n t s , c h i l d r e n and m o d e r a t e l y incapacitated adults with feeding." I I . 6.0 " A s s i s t i n s u p p o r t i n g an i n d i v i d u a l a n d a f a m i l y t o meet t h e i r needs f o r s e c u r i t y i n a p p r o v e d a n d / o r p r e s c r i b e d ways." I I I . "Promote i n d e p e n d e n c e i n h e r c l i e n t s r e g a r d i n g a c t i v i t i e s of daily living."  Stage I I Homemaker p r a c t i c e d a t a i n d i c a t e s 19% of t h e c l i e n t s i n 1980 r e c e i v e d service. V.C.C. C u r r i c u l u m i n d i c a t e s T e r m i n a l G o a l s E a n d G; a n d I n t e r i m O b j e c t i v e s E.I., E . I I . , G.I., G . I I . , G . I I . 1 . 0 , G.II.2.0, G . I I . 3 . 0 , G.I I . 4 . 0 , G . I I . 5 . 0 , G . I I . 6 . 0 , and G . I I I . related to P r a c t i c e C a t e g o r y 8.0. Stage I I I V.C.C. Curriculum i n d i c a t e s student w i l l be a b l e t o assist client in the f o l l o w i n g a r e a s (examples g i v e n ) :  Stage IV Data i n d i c a t e s congruence i n practice category.  "Performing t h e s p e c i f i c s k i l l s of baby b a t h s , b a t h i n g a c h i l d c o n f i n e d t o b e d , d i a p e r i n g an infant, bottle feeding infants, p r o v i d i n g f e e d i n g r e q u i r e d by i n f a n t s and t o d d l e r s . " Student G u i d e l i n e s i n d i c a t e extensive individual/group activities, f i l m s t r i p s and d i s c u s s i o n r e l a t e d to care f o r c h i l d r e n . P r a c t i c e C a t e g o r y 7.0 i s an example o f an i n t e g r a t e d c a t e g o r y , i n v o l v i n g T r a c k C ( P r o t e c t i o n i n t h e Home), Track D ( N u t r i t i o n ) , Track E (Growth and D e v e l o p m e n t ) , Track F (Communication), and Track G (Health).  61  Table X I I (continued) Homemaker P r a c t i c e C a t e g o r i e s  8.0 C l e a n , a n d 9.0 Do L a u n d r y  Stage I Terminal Interim  Goal: Objectives:  T r a c k C. "Meet n e e d s f o r i n t h e home." C. C. C. C. C. C. c. c. c. c. c. c. c. c. c. c. c.  protection  V. "Know a p p r o v e d methods f o r c o n t r o l l i n g common h a z a r d s t o s a n i t a t i o n i n t h e home." V I . 1.0 "Know b a s i c p r i n c i p l e s u n d e r l y i n g home c l e a n i n g a n d maintenance." V I . 1.2 " D e s c r i b e t h e m a j o r p r i n c i p l e s i n v o l v e d i n home cleaning." V I . 2.0 " L i s t - common p r o c e d u r e s i n v o l v e d i n a home c l e a n i n g plan." VI. 3.0 "Know t h e b a s i c s o f laundering." 4.0 "Do l a u n d r y . " VI 5.0 " U s e , c l e a n , a n d m a i n t a i n VI a refrigerator-freezer." 6.0 "Use, c l e a n , a n d . m a i n t a i n VI a k i t c h e n range." 7.0 " U s e , c l e a n , a n d m a i n t a i n VI a dishwasher." 8.0 " P r o v i d e f l o o r c a r e . " VI 9.0 " P r o v i d e r u g a n d c a r p e t VI care." VI. 10.0 " C a r e f o r w a l l s a n d woodwork VI . 11.0 " C a r e f o r f u r n i t u r e , w i n d o w s , and m i r r o r s . " VI . 12.0 "Use, c l e a n , a n d maintain cleaning t o o l s . " VI. 13.0 " C l e a n t h e b a t h r o o m . " VI. 14.0 "Use, c l e a n , a n d maintain cleaning t o o l s . " VI. 15.0 " G i v e n a s p e c i f i c f a m i l y and home s i t u a t i o n , u s e a home c l e a n i n g and m a i n t e n a n c e p l a n . "  62  S t a g e 11 Homemaker p r a c t i c e d a t a i n d i c a t e s 5 2 % of t h e c l i e n t s i n 1980 r e c e i v e d s e r v i c e i n P r a c t i c e 8.0; and 27% r e c e i v e d s e r v i c e i n P r a c t i c e 9.0. V.C.C.Curriculum i n d i c a t e s Terminal G o a l C. and I n t e r i m Objectives C.V. and C.VI.1.0 t o C.VI.15.0 are r e l a t e d t o P r a c t i c e C a t e g o r i e s 8.0 and 9.0. Stage I I I V.C.C. Curriculum i n d i c a t e s student w i l l be a b l e t o assist client in the f o l l o w i n g a r e a s (examples g i v e n ) : Stage IV Data i n d i c a t e s congruence i n practice categories.  "Do l a u n d r y and c l e a n . " S t u d e n t g u i d e l i n e s i n d i c a t e a minimum of 56 h o u r s and 30 m i n u t e s o f independent/group a c t i v i t y , postt e s t i n g , and f i e l d a s s i g n m e n t s .  63  Table XII Homemaker P r a c t i c e C a t e g o r y  10.0  (continued) P r e p a r e M e a l s and  11.0  -Shop f o r  Groceries  Stage I Terminal Goal:  T r a c k D. the  Interim  D.  Objectives:  D.  D.  D. D.  D.  "Meet needs f o r . n u t r i t i o n , i n home."  I. "Identify basic n u t r i t i o n a l n e e d s of an i n d i v i d u a l and a family." I I . I d e n t i f y the major i n f l u e n c e s w h i c h a f f e c t how an i n d i v i d u a l and/or f a m i l y meets t h e i r n u t r i t i o n a l needs. I I I . " O u t l i n e m e a l p l a n s t o meet t h e n u t r i t i o n a l n e e d s of an i n d i v i d u a l or f a m i l y i n g i v e n field situations." IV. " D e m o n s t r a t e a p p r o v e d ways of m e e t i n g n u t r i t i o n a l n e e d s of a i n d i v i d u a l or f a m i l y . " V. " E v a l u a t e the continuing e f f e c t i v e n e s s of t h e n u t r i t i o n a l p l a n f o r an i n d i v i d u a l a n d / o r family." VI. "Demonstrate a p e r s o n a l c o m m i t t m e n t t o t h e p u r s u i t of adequate n u t r i t i o n f o r h e r s e l f and h e r c l i e n t s . "  Stage II Homemaker p r a c t i c e d a t a i n d i c a t e s 28% of t h e c l i e n t s i n 1980 received service in practice category 10.0; and 32% r e c e i v e d s e r v i c e i n p r a c t i c e category 11.0. V.C.C. C u r r i c u l u m i n d i c a t e s T e r m i n a l G o a l D. and I n t e r i m Objectives D.I. t o D.VI. are r e l a t e d to P r a c t i c e C a t e g o r i e s 10.0 and 11.0.  64  Stage I I I V.C.C. C u r r i c u l u m i n d i c a t e s student w i l l be a b l e t o assist client in the f o l l o w i n g areas (examples g i v e n ) :  Stage  IV Data i n d i c a t e s congruence i n practice categories.  " O r g a n i z e and i m p l e m e n t d a i l y and w e e k l y meal p l a n s . " "Purchase food a c c o r d i n g to a food plan." "Prepare food f o r c l i e n t consumption." S t u d e n t g u i d e l i n e s i n d i c a t e a minimum of 33 h o u r s o f i n d e p e n d e n t a c t i v i t i e s , w h o l e g r o u p and s m a l l group a c t i v i t i e s , f i l m s , l e c t u r e s and d i s c u s s i o n s .  65  Limitations  of t h e Study  I t h a s been t h e i n t e n t o f t h e w r i t e r detail  t h e r o l e , theory and p r a c t i c e  to describe with  o f a p a r t i c u l a r homemaker  group from t h e lower m a i n l a n d of B r i t i s h C o l u m b i a . boundaries within to describe with  t h i s t h e s i s were d e l i b e r a t e l y some d e p t h a n d p r e c i s i o n  r e s u l t s of t h i s The  detail  thesis  l i m i t e d i n order  to  generalize  thesis.  evaluative  mode was c h o s e n a s a way o f p r o v i d i n g i n  t h e homemaker's t h e o r y a n d p r a c t i c e .  underpinning that  The r e s e a r c h  a s p e c i f i c body o f  homemakers.. As a r e s u l t , i t may n o t be p o s s i b l e the  some  provides a contextual  i s p r e s e n t e d a s an e s s e n t i a l  The s o c i o l o g i c a l  framework f o r t h i s  f o u n d a t i o n on w h i c h o u r  u n d e r s t a n d i n g s o f t h e homemaker's r o l e , t h e o r y , a n d p r a c t i c e c a n be  based. In  writer  further  o u t l i n i n g the l i m i t a t i o n s of t h i s t h e s i s the  wishes t o point  practice  data that  out c e r t a i n areas of t h e t h e o r y and  have been a c c e p t e d a s u n t e s t e d .  t h e r e may be a d d i t i o n a l a r e a s o f d i s c r e p a n c y  F o r example,  involving  the exact  number o f h o u r s t h a t  a c t u a l l y go i n t o t h e o v e r a l l p r o c e s s o f  homemaker t r a i n i n g .  Furthermore, the c l i e n t  nominal areas of p r a c t i c e . hours of a l l p r a c t i c e determined.  within  files  indicate  only  The e x a c t measurement o f t h e a c t u a l a g i v e n c l i e n t ' s home h a s y e t t o be  The l i m i t a t i o n s o f t h i s t h e s i s a r e p r o v i d e d i n  order t o c l a r i f y  as w e l l as t o suggest f u r t h e r  area.  A participant  useful  i n i l l u m i n a t i n g these  research  o b s e r v e r mode o f i n q u i r y c o u l d  in this  be most  questions.  T h i s c h a p t e r has p r e s e n t e d a l l t h e d a t a a n a l y s e s except t h e interview  findings.  The i n t e r v i e w  findings  are included  with  66  the  overall  practice  d i s c u s s i o n o f t h e homemaker r o l e ,  that w i l l  appear  i n Chapter VI.  theory,  and .  67  C h a p t e r VI  DISCUSSION AND RECOMMENDATIONS  Change a n d I t s I m p l i c a t i o n s Whereas, t h e c l i e n t 1976 due  counterpart,  i n 1980 d i f f e r s  significantly  from h e r  i t c a n n o t be a r g u e d t h a t t h i s c h a n g e i s s o l e l y  t o t h e c r e a t i o n o f Long Term C a r e i n 1978. C l i e n t s w i t h  personal increased  care  n e e d s i n 1980 who were n o t a s s o c i a t e d w i t h LTC  significantly.  i n 1980 who e x p e r i e n c e d  The same i s t r u e  f o r non-LTC  p s y c h i a t r i c as w e l l as medical  clients problems.  V i e w e d a s a w h o l e , t h e homemaker s i t u a t i o n a p p e a r s t o d i s p l a y a number o f i n h e r e n t from t h e r e s e a r c h  problems.  The i n f e r e n c e s  are related s p e c i f i c a l l y  t h a t c a n be drawn  t o the r o l e ,  theory,  and  p r a c t i c e o f t h e homemaker a s i t a f f e c t e d b o t h t h e LTC a n d  the  non-LTC The  client.  overall  f i n d i n g s i n t h i s area  homemaker h a s c h a n g e d s i g n i f i c a n t l y  between  homemaker a p p e a r s t o have been p l a c e d i n c r e a s i n g demands a r e b e i n g  placed  a notable  1976 a n d 1980. The  in a situation  i n which  on h e r c a p a c i t y t o meet t h e  r a p i d l y c h a n g i n g needs of h e r c l i e n t . o l d e r , having  were t h a t t h e r o l e o f t h e  Not o n l y  degree of medical  i s her c l i e n t  and p s y c h i a t r i c  problems t h a t o f t e n n e c e s s i t a t e a m y r i a d a r r a y of complex care  s e r v i c e s , but t h i s  same c l i e n t  u n i t a n d may be more s o c i a l l y counterpart.  i s part of smaller  isolated  health  family  t h a n was h e r 1976  68  R o l e o f t h e Homemaker a s t h e "Good S a m a r i t a n " One o f t h e more i n t r i g u i n g a s p e c t s o f t h e homemaker r o l e i s that  o f t h e homemaker a s t h e "Good S a m a r i t a n "  relationship with  the c l i e n t .  homemaker s u p e r v i s o r s sample c l i e n t with  files  i n her  The i n t e r v i e w s c o n d u c t e d w i t h t h e  and t h e v a r i o u s  notations  t h a t a p p e a r on  a p p e a r t o a f f i r m t h i s phenomena a s o c c u r r i n g  some r e g u l a r i t y .  The P o s i t i o n P a p e r o f t h e V.C.C.  Homemaker P r o g r a m i n i t s r e s p o n s e t o t h e P e r s o n a l Guidelines  o f t h e homemaker a g e n c i e s w i t h i n B.C.  references  t h a t c a n be c o n s t r u e d  as being  Assistance also  contains  related to this  h e l p i n g mode o f t h e homemaker. In t h e m a j o r i t y  o f t h e two h u n d r e d c l i e n t  case f i l e s  were r e a d f o r t h e p u r p o s e o f d a t a a n a l y s i s i n t h i s homemaker a p p e a r e d t o be p e r f o r m i n g s e r v i c e s could  be d e s c r i b e d  agency f i l e s in:  as housekeeping d u t i e s .  she w o u l d f r e q u e n t l y  "helping Mrs.  a l s o prepare a l i g h t there  f o r the c l i e n t  that  For example, i n t h e  be d e s c r i b e d  as being  involved  do t h e w e e k l y s h o p p i n g " ; "may need t o lunch  on some d a y s " .  The a r e a s i n w h i c h  homemaker p r o g r a m t r a i n i n g d i v i s i o n , a n d  concerned homemaker-oriented b o d i e s appear t o f o l l o w  some p r e c i s i o n t h e e x a c t o u t l i n e o f d i s c r e p a n c y in  study, the  a p p e a r s t o be a p r o b l e m f o r t h e homemaker, t h e homemaker  a g e n c y , t h e V.C.C. other  that  the Provus a n a l y s i s .  broad category that could assistance  These a r e a s o f c o n c e r n f a l l  and a r e the p r a c t i c e c a t e g o r i e s  care  o f : monitoring  a s s i s t i n g the c l i e n t  found  into a  be r e f e r r e d a s s p e c i a l h e a l t h  s t a t e of h e a l t h of the c l i e n t ; medication;  t h a t were  with  the  with  a n d r e p l a c i n g Home C a r e n u r s e s on a t e m p o r a r y  basis.  T h e s e same p r a c t i c e a r e a s a l s o c o n s t i t u t e s e r v i c e c a t e g o r i e s i n  69  w h i c h t h e homemaker may be i n v o l v e d w i t h t h e c l i e n t s i t u a t i o n where t h e "Good S a m a r i t a n " This particular  principle  i na  i s operative.  s i t u a t i o n a n d t h e c o n c e r n s c r e a t e d by t h e s e  homemaker p r a c t i c e s a r e f o u n d t o be an o f t e n r e p e a t e d the  i n t e r v i e w s w i t h t h e s u p e r v i s o r s o f t h e homemakers o f t h i s  agency.  F o r e x a m p l e , one o f t h e s u p e r v i s o r s i n h e r comments  regarding  t h e r o l e o f t h e homemaker r e p l i e d : " . . . s o m e t i m e s  homemakers a r e i n v o l v e d i n b a s i c n u r s i n g a r e a s shouldn't she  theme i n  be i n . . . . s h e  has t o take  ( t h a t ) she  d o e s n ' t have n u r s i n g t r a i n i n g .  o v e r f o r t h e Home C a r e N u r s e b e c a u s e  aren't  enough o f t h e s e  n u r s e s t o go a r o u n d .  crisis  incertain situations.  They  Sometimes there  Problems a r i s e  i na  ( t h e homemakers) a r e t h e  o n l y p e o p l e who c a n h e l p . " Another supervisor certain one  summarized t h e r o l e as b e i n g :  s i t u a t i o n s t h e homemaker t a k e s  else there  t o do i t . . . . " .  shouldn't  be d o i n g  The  this...we  need more Home C a r e  homemaker nurses."  role are succinctly delineated i n the  p o s i t i o n paper r e g a r d i n g  g u i d e l i n e s o f homemaker a g e n c i e s states:  "....the  voiced  theme o f t h e homemaker a s t h e Good S a m a r i t a n a n d t h e  concerns r a i s e d about t h i s V.C.C.  o v e r b e c a u s e t h e r e ' s no  And a n o t h e r s u p e r v i s o r  concern over t h e g i v i n g of medications:  "....in  the personal (June,  1980).  assistance This  paper  "The h i s t o r y o f homemaking i n B r i t i s h C o l u m b i a t e n d s t o  give r i s e  t o a v i e w o f t h e homemaker a s a k i n d l y m o t h e r  surrogate  or family f r i e n d .  These k i n d s of a t t r i b u t e s a r e  commendable i n t h e p e r f o r m a n c e o f some homemaking t a s k s , b u t i t must be c l e a r l y  understood that  i n t h e eyes of t h e law t h e  homemaker d o e s n o t h a v e t h e f r e e d o m t o p e r f o r m many a c t s w h i c h a  70  f a m i l y member c o u l d do w i t h In far  impunity."  t e r m s o f t h e c o n t e m p o r a r y r o l e o f t h e homemaker a n d t h e  reaching consequences of t h i s expanding r o l e ,  director  of t h e agency r e s e a r c h e d  feelings  i n an a n n u a l  members a s f o l l o w s :  for this  study,  the executive summed up her.  r e p o r t t o t h e homemaker a s s o c i a t i o n  "The B o a r d o f D i r e c t o r s i s v e r y aware o f t h e  e x p a n d i n g r o l e o f t h e homemaker i n t h e h e a l t h c a r e i m p l i c a t i o n s of t h i s .  field  and t h e  I n many cases- i t w o u l d be d i f f i c u l t t o  d e f i n e t h e d i f f e r e n c e between a homemaker a n d a p r a c t i c a l nurse." situation  I n many c a s e s  t h i s d o e s i n d e e d a p p e a r t o be t h e r o l e  o f t h e homemaker.  Furthermore,  i n c r e a s i n g demands f o r c o m p l e x i t y homemaker's r o l e may c o n t i n u e  given the probable  o f homecare a s s i s t a n c e , t h e  i t s metamorphic development  from  that of housekeeping t o the emerging r o l e of the h e a l t h care . assistant  i n t h e home.  Interpretation  o f T h e o r y a n d P r a c t i c e o f t h e Homemaker  As p r e v i o u s l y s t a t e d , t h e t h r e e a r e a s o f t h e o r y / p r a c t i c e discrepancy  noted  in this  study  assistance to certain clients Care nurse, states.  i n v o l v e t h e homemaker's  i n t e m p o r a r i l y r e p l a c i n g t h e Home  administering medications,  and m o n i t o r i n g  An e x a m p l e o f t h e homemaker a s Home C a r e  nurse  s u b s t i t u t e c a n be i l l u s t r a t e d by a h a n d i c a p p e d c l i e n t e x t e n s i v e d e c u b i t u s u l c e r s who r e q u i r e d a b e d b a t h . had  been r e q u e s t e d ,  b u t was n o t a v a i l a b l e .  not  t r a i n e d t o r e p l a c e t h e Home C a r e n u r s e ,  health  with Home C a r e  The homemaker was but d i d so.  In the  second a r e a , c e r t a i n c l i e n t s ' s c h a r t s i n d i c a t e d d i f f i c u l t y  with  71  self-administration  of m e d i c a t i o n ,  r e q u e s t e d t o a s s i s t them. states a typical cardiovascular  In the area of m o n i t o r i n g  e x a m p l e was t h a t o f a c l i e n t  outside  the confines  These t h r e e  health  with  p r o b l e m s who r e q u i r e d m o n i t o r i n g  r e l a t e d t o m e d i c a t i o n usage. clearly  a n d t h e homemaker was  of pulse  rate  areas of p r a c t i c e a r e  of t h e f o r m a l  V.C.C.  homemaker  program. In an a t t e m p t t o f u r t h e r e x p l a i n t h i s phenomena o f discrepancy, V.C.C.  homemaker s u p e r v i s o r  p r o g r a m , a n d t h e homemaker a g e n c i e s were  Interviews.with their  i n t e r v i e w s , documents from t h e  homemaker s u p e r v i s o r s  explored  i n t e r p r e t a t i o n o f t h e homemaker r o l e ,  majority  awareness t h a t providing V.C.C.  In t h i s area of theory  of t h e s u p e r v i s o r s  prefaced  and p r a c t i c e a  r e m a r k s by s t a t i n g an  However, i n t h e s e i n s t a n c e s ,  r e f e r r e d back t o t h e i r  S a m a r i t a n " r o l e o f t h e homemaker. supervisors  majority,  o f homemaker  s e r v i c e s t h a t do n o t m a t c h t h e t h e o r y  frequently  their  i n c e r t a i n s i t u a t i o n s t h e homemaker may be  program.  training  their  not only  but a l s o  c o n c e r n s a b o u t t h e c o n g r u e n c e and d i s c r e p a n c y p r a c t i c e and t h e o r y .  analyzed.  felt  the supervisors  statements regarding  receive  areas of d i s c r e p a n c y .  t h e f e e l i n g was t h a t  t h e "Good  O n l y one o f t h e f o u r  t h a t t h e homemaker s h o u l d  i n these s p e c i f i c  t a u g h t by t h e  formal For the  the present curriculum  of t h e  homemaker t r a i n i n g p r o g r a m was more t h a n a d e q u a t e a n d t h a t t h e homemaker s h o u l d or n u r s e ' s a i d e .  avoid  t a k i n g on t h e r o l e o f a p r a c t i c a l  An e x p a n s i o n o f t h e s e r v i c e a n d c l i e n t  t h e Home C a r e n u r s e was s e e n a s b e i n g  nurse use of  the s o l u t i o n to the  p r o b l e m o f homemaker p r a c t i c e t h a t a t t i m e s may be  nursing  72  rather  than  housekeeping.  O t h e r g r o u p s have a l s o d i s p l a y e d c o n c e r n s practice/theory discrepancy homemaker s e r v i c e . concerns  that exists  One o f t h e c e n t r a l  about the  i n c e r t a i n areas of groups v o i c i n g i t s  i s t h e c o m m u n i t y c o l l e g e i n w h i c h t h e homemaker p r o g r a m  was d e v e l o p e d .  As was t h e c a s e  the p o s i t i o n paper of t h i s  w i t h t h e r o l e o f t h e homemaker,  institution  regarding the personal  a s s i s t a n c e g u i d e l i n e s f o r t h e homemaker o u t l i n e d d e t a i l e d concerns  regarding this  One o f t h e more c r i t i c a l t h e homemaker's a s s i s t i n g V.C.C.  situation.  areas  that:  i n v o l v e s t h a t of  with medications.  The  s t a t e s t h a t : "The homemaker  should not administer medications (V.C.C.  of concern  the c l i e n t  p o s i t i o n paper c l e a r l y  some r a t h e r  i n any  P o s i t i o n P a p e r , page 6 ) .  circumstances."  T h i s p a p e r g o e s on t o s t a t e  " I t a p p e a r s t h a t homemaker a g e n c i e s  are attempting to  respond  t o meet c l i e n t  needs f o r m e d i c a t i o n  current  s y s t e m w h i c h d o e s n o t p r o v i d e a d e q u a t e s u p e r v i s i o n by  appropriate nursing professionals.  officials  This position  does not appear t o concur  i n the  The a n s w e r i s n o t t o p r o v i d e  s e r v i c e by p u t t i n g t h e homemaker i n l e g a l P o s i t i o n P a p e r , page 7 ) .  treatment  jeopardy."  (V.C.C.  o f t h e homemaker p r o g r a m  w i t h t h e Community Homemaker  S e r v i c e s A s s o c i a t i o n o f B r i t i s h C o l u m b i a G u i d e l i n e s t h a t were drafted  i n 1979, a n d i n u s e i n 1980, i n w h i c h on page 2 t h e  following g u i d e l i n e s are given concerning administration:  "Medication  homemaker u n t i l  such  do  medication  i s n e v e r t o be a d m i n i s t e r e d by t h e  time as she has r e c e i v e d a u t h o r i z a t i o n t o  so f r o m h e r s u p e r v i s o r . . . . O n l y o r a l m e d i c a t i o n  may be g i v e n  by a homemaker, a n d i f t h e r e i s a n y o t h e r p o s s i b l e o p t i o n f o r  73  the a d m i n i s t r a t i o n o f m e d i c a t i o n , involved." to  Here a g a i n ,  t h e "Good S a m a r i t a n "  be o p e r a t i o n a l e v e n w i t h i n t h e s e Pursuing  being  t h i s area  during  principle  appears  guidelines.  of d i s c r e p a n c y  areas of personal  into the s p e c i f i c  agency  1980.  c a r e a s s i s t a n c e s u r f a c e d many  T y p i c a l of these  D i r e c t o r s m e e t i n g o f June expressed  their  homemakers b e i n g to  n o t be  i n v e s t i g a t e d , c o n c e r n s o v e r homemaker i n v o l v e m e n t i n  certain  had  t h e homemaker s h o u l d  the c l i e n t .  d i s c u s s i o n s was a B o a r d o f  1980 i n w h i c h c e r t a i n b o a r d  concerns regarding  the l e g a l  members  i m p l i c a t i o n s of  involved with the a d m i n i s t r a t i o n of medication These minutes a l s o r e f l e c t  Board about t h e need f o r c l a r i f i c a t i o n g o v e r n m e n t a s t o who s h o u l d such a c r i t i c a l  times  a concern f e l t  by t h e  by t h e p r o v i n c i a l  a u t h o r i z e or take  responsibility for  s e r v i c e t o the c l i e n t .  Four months l a t e r ,  the Board minutes of October  that the agency's e x e c u t i v e  14 r e v e a l  d i r e c t o r h a d been a p p o i n t e d  t o an  i n t e r d i s c i p l i n a r y committee f o r t h e purpose o f s t u d y i n g t h e ongoing  problem of personal One month l a t e r ,  displays to  care  a memo t o B o a r d members on November 7  f u r t h e r concerns with t h i s area  t h e 1978 G u i d e l i n e s  activities  of personal  care.  a t length the M i n i s t r y Guidelines that t h e homemaker c o u l d p r o v i d e  been met.  Referring  concern about the ambiguity  of d i r e c t i o n w i t h i n t h e area discussed  of p r a c t i c e .  i s s u e d by t h e M i n i s t r y o f H e a l t h , t h e  agency's d i r e c t o r expressed  had  a s s i s t a n c e by t h e homemaker.  and lack  The memo listed  when c e r t a i n c o n d i t i o n s  F o r e x a m p l e , c e r t a i n d u t i e s c o u l d be c a r r i e d o u t  "when t h e Homemaker A g e n c y S u p e r v i s o r homemaker h a s a d e q u a t e s k i l l s  i s assured  and t r a i n i n g  that the  t o perform the tasks  74  r e q u i r e d t o meet t h e i n d i v i d u a l n e e d s o f t h e c l i e n t .  (Note  t h e r e a r e no g u i d e l i n e s a s t o ' a d e q u a t e t r a i n i n g ' ) . "  And on t h e  matter  of m e d i c a t i o n  expresses  concern  specifically,  after  with:  'Assistance with the following  f u n c t i o n s c a n be u n d e r t a k e n  individual  professional  instruction  i f a p p r o p r i a t e and o n l y  and d i r e c t i o n  involved with the i n d i v i d u a l  T h e r e i s no d e f i n i t i o n of a c t i v i t i e s  same B o a r d memo  a b o u t t h e f a c t t h a t : "The s e c o n d s e c t i o n o f  the G u i d e l i n e s i s p r e f a c e d personal  this  f r o m an a p p r o p r i a t e r e c e i v i n g care'(Note:  o f ' a p p r o p r i a t e p r o f e s s i o n a l ' ) . The  include: Assistance with oral medication i f  homemaker h a s been g i v e n w r i t t e n o r d e r . . . . " . of p e r s o n a l c a r e a s s i s t a n c e t o t h e c l i e n t going  list  The o v e r a l l  area  appeared t o c r e a t e on-  p r o b l e m s f o r t h e a g e n c y a n d i t s homemakers.  Conclusions I t w o u l d a p p e a r t h a t t h e homemaker, t h e a g e n c i e s , t h e t r a i n i n g programs, the M i n i s t r y of H e a l t h t h a t homemaker s e r v i c e s , and l a s t , clients  but not l e a s t ,  purchases  t h e homemaker  t h e m s e l v e s a r e p l a c e d w i t h i n an e n i g m a t i c  T h e r e i s no s i m p l e , c l e a r c u t s o l u t i o n  situation.  t o t h e p r o b l e m t h a t now  exists. Viewing  t h i s complex s i t u a t i o n  t h e o r y , and p r a c t i c e from a B e r g e r  o f t h e homemaker's  a n d Luckman p o i n t o f v i e w ,  the o w n e r s h i p of knowledge r e l a t e d e s p e c i a l l y  t o t h e area of  p e r s o n a l c a r e a s s i s t a n c e , and a l s o t h e c o r r e s p o n d i n g that  k n o w l e d g e , a p p e a r s t o n o t be c l e a r l y  p a r t i e s concerned  (Berger  role,  c o n t r o l of  established for a l l  and Luckman,1966).  75  At social from  the  same  service  the  more  time,  assistance rigidly  as  hospitals,  of  previous, areas  say  that  the  there  appears  hospital  settings  that  over  this  study, to  of  aide  the  that  the  into  home  the  health  and p r a c t i c e  aide,  example,  loosening  control.  within  most  That  is  to  hospital  a well  defined  and c o n c i s e l y  executed  t r a i n i n g program and the  corresponding  practice  is  the  expected  homemaker  demarkations  to  defined  such  is  the  than  problems  as  certain  w i t h the  clients  same It  as  milieu do  of  not  p r e c i s i o n as  would then  with health  advantages,  most  the  research  institutional settings well  In  and c o n t r o l boundaries  institutional settings. of  role.  perform within  within  established  rather  the care  Maclntyre will  long  best  The complex  i n her  for to  to  the what  third  service  that  appear  care  carries  both to  of  the  create  a  sense  is  best  issue is  that  appears  that  British of  client  for  the  be  the  assistance,  review  situations  There  may w e l l  homemaker  situation  i n many  clients.  run i t  and s o c i a l  continue  opposed  may  occurred a corresponding  for  away  needs  with  the  it  client  and  taxpayer. In  is  and  institutional settings,  knowledge  there  dispersal  specific  settings  and  well  been  in  i n home  health  rather  For  have  clients  of  a  these  appear  dispersement  controlled,  have  individual  institution. this  of  to  the  to  may h a v e  nurse's  settings  control  w i t h the  the  on-going the  taxpayers to  be  to  be  the  have  best  been,  of  of  the  tension home the  balance  seventies, between  setting  solution especially  what  as  province.  home c a r e for  of  by  intertwined with  p o s s i b i l i t y that  not  documented  system  within  appears  delicate  this  assistance many  during  the  76  s e v e n t i e s , an u n d e r s t a n d i n g  t h a t home c a r e  was t h e u l t i m a t e  answer t o t h e p r o b l e m o f h e a l t h and s o c i a l the  chronically i l l ,  While t h i s medically it  the e l d e r l y ,  form of a s s i s t a n c e  related  and t h e dependent  i s both cost  e f f e c t i v e f o r some c l i e n t s ,  i s suitable f o ra l l .  this  b e n e f i c i a l and that  o f any r e s e a r c h  o f f a c t o r s t h a t must be  form of a s s i s t a n c e ,  individual.  i t c a n n o t be assumed  Given the paucity  t o the m u l t i p l i c i t y  in assessing  service assistance to  considered  i t s w i d e s p r e a d u s e must be  questioned. The those  final  involved  i s s u e t h a t a p p e a r s t o be a c o n t i n u a l p r o b l e m f o r i n t h e homecare s e r v i c e a r e a  who i s u l t i m a t e l y i n c o n t r o l o f t h i s e n t i t y homemakers.  At present,  without  i s the q u e s t i o n of we r e f e r t o a s  the existance  o f some f o r m o f  l i c e n s u r e o f t h e homemakers, t h e i r c o n t r o l b o u n d a r i e s a r e v e r y ill  defined.  widely  The l e v e l s o f t r a i n i n g  throughout the province.  o f t h e homemakers  vary  Some o f t h e s e homemakers h a v e  been t r a i n e d by t h e community c o l l e g e homemaker p r o g r a m s . O t h e r s have o n l y m i n i m a l on t h e j o b t r a i n i n g .  The c l i e n t , i t  a p p e a r s , h a s no a s s u r a n c e o f u n i f o r m i t y o f t r a i n i n g . the  practice discrepancies  defined  research  area  that appear w i t h i n t h i s c l o s e l y  may be much more e x t e n s i v e  a g e n c i e s a n d t h e i r homemakers. discrepancy some c l e a r l y all  will  continue  Indeed,  f o r other  This contemporary s t a t e of  to exist until  e s t a b l i s h e d , uniform  such time that t h e r e i s  guidelines for a l l agencies,  t r a i n i n g p r o g r a m s , a n d a l l homemakers p r a c t i c i n g i n t h e  province.  77  Recommendat i o n s Having s t u d i e d the research f i n d i n g s r e l a t e d . t o the homemaker, t h e w r i t e r makes t h e f o l l o w i n g concerning  the occupation  P r o v i n c e of B r i t i s h  recommendations  o f homemaking a s i t e x i s t s w i t h i n t h e  Columbia.  1) I t i s recommended t h a t t h e M i n i s t r y c o n s u l t a t i o n w i t h a l l homemaker a g e n c i e s t r a i n i n g programs  of H e a l t h , i n  and a l l homemaker  throughout the province, should  establish  c l e a r - c u t g u i d e l i n e s f o r t h e r o l e a n d p r a c t i c e o f t h e homemaker that w i l l I  be u n i f o r m  in their  u s e a g e by homemakers a n d  strictly  I  -- —  enforced  throughout the p r o v i n c e .  Ministry  of H e a l t h  Finally,  that the  i n the P r o v i n c e of B r i t i s h Columbia  assume t h e u l t i m a t e l e g a l practice.  Additionally,  —  should  l i a b i l i t y i n t h e a r e a o f homemaker  w i t h i n t h i s a r e a o f homemaker p r a c t i c e  s h o u l d be v e r y c l o s e s u p e r v i s i o n o f a g e n c i e s  there  a n d homemakers f o r  the purpose of a s s u r i n g o p t i m a l , s a f e l e v e l s of s e r v i c e t o a l l clients. 2) I t i s recommended t h a t a p r o c e s s homemaker be i n s t i t u t e d .  of l i c e n s i n g t h e  T h i s a c t of l i c e n s i n g  throughout t h e p r o v i n c e would serve t o assure homemaker, e m p l o y e d  homemakers  the c l i e n t  that a  by any g i v e n a g e n c y w i t h i n t h e p r o v i n c e ,  w o u l d i n f a c t h a v e r e c e i v e d a d e q u a t e homemaker t r a i n i n g a n d would possess the proper client  q u a l i f i c a t i o n s needed  t o meet  specific  needs.  3) In t h e area of t r a i n i n g ,  i t i s recommended t h a t t h e  p r o v i n c i a l and/or t h e f e d e r a l government educational  provide  adequate  f u n d i n g a s s i s t a n c e f o r homemakers a l r e a d y  who have n o t r e c e i v e d f o r m a l t r a i n i n g  i n homemaking.  practicing  78  F u r t h e r m o r e , t h e s e homemakers s h o u l d their not  t r a i n i n g l e v e l s by s u s t a i n e d  only  their  government  that  i s the ultimate  involved  educational all  s u p p o r t and encouragement of  a g e n c y e m p l o y e r s b u t a l s o by t h e p r o v i n c i a l p u r c h a s e r of t h e i r  4) I t i s a l s o recommended t h a t currently  be e n c o u r a g e d t o u p g r a d e  t h e community  service. colleges  i n t h e t r a i n i n g o f homemakers e x p a n d  expertise  their  t o make a v a i l a b l e i n - s e r v i c e p r o g r a m s f o r  homemaker a g e n c i e s w i t h i n t h e p r o v i n c e . 5) The f i n a l  accelerated concerns.  recommendation i s t h a t  research  there  w i t h i n t h e b r o a d a r e a o f homemaker  G i v e n the r a p i d l y changing dimensions of t h e  homemaker's r o l e a n d p r a c t i c e , i t i s i m p e r a t i v e r e l a t e d t o these areas, an o c c u p a t i o n a l research  be e x p a n d e d and  that  decisions  a n d i n d e e d t o t h e w h o l e o f homemaking a s  e n t i t y , be a s s i s t e d by means o f o n - g o i n g  and development.  79  References  Research  A r t i c l e s and Books  B e r g e r , P e t e r L. of R e a l i t y . 1 966.  a n d Luckman, Thomas. The S o c i a l C o n s t r u c t i o n G a r d e n C i t y , New.York: D o u b l e d a y a n d Company,  H o l s t i , O l e . Content A n a l y s i s f o r t h e S o c i a l S c i e n c e s and Humanities. Don M i l l s , O n t a r i o : A d d i s o n - W e s l e y Publishing Company, 1969. L e w i s , D . J . , a n d S c h e u r e n , M.T.. Home H e a l t h Management A s s i s t a n t : R e p o r t , 1975. ERIC Document R e p r o d u c t i o n S e r v i c e No. ED.122079. Maclntyre, Sally. " O l d Age As A S o c i a l P r o b l e m " , i n R. D i n g w a l l ( E d . ) , H e a l t h Care and H e a l t h Knowledge. London: Croom Helm, L t d . , 1977. Provus, Malcolm. Discrepancy E v a l u a t i o n . P u b l i c a t i o n C o r p o r a t i o n , 1971. Rhodes, P h i l i p . The V a l u e o f M e d i c i n e . and Unwin L t d . , 1976.  B e r k e l e y : McCutchan  Chicago:  George  Allen  Ripple, Helen. S u p e r v i s i o n o f t h e P a r a p r o f e s s i o n a l , 1973. ERIC Document R e p r o d u c t i o n S e r v i c e No. ED. 087528. R o b i n s o n , N a n c y . C o s t s o f Homemaker-Home H e a l t h A i d e , 1974. ERIC Document R e p r o d u c t i o n S e r v i c e No. ED. 107879. S h i p l e y , Anna. A n a l y s i s o f T a s k s i n T h r e e Home R e l a t e d O c c u p a t i o n s , 1967. ERIC Document R e p r o d u c t i o n S e r v i c e No. ED. 026484. Webb, E . J . , . a n d C a m p b e l l , D.T., S c h w a r t z , R.D., a n d S e c h e r t , L. Unobtrusive Measures: n o n r e a c t i v e r e s e a r c h i n t h e s o c i a l sciences. C h i c a g o : R a n d - M c N a l l y , 1966. Webb, E . J . , a n d S a l a n c i k , J.R. " N o t e s on t h e S o c i o l o g y o f Knowledge." J o u r n a l i s m Q u a r t e r l y , 1965.  80  Survey  Reports  R e p o r t on Homemakers and R e l a t e d S e r v i c e s i n G r e a t e r Vancouver.. Mary M e r c e r , c o - o r d i n a t o r . P r e p a r e d by t h e G r e a t e r V a n c o u v e r S o c i e t y f o r C o - o r d i n a t i n g Home S e r v i c e s , V a n c o u v e r , November, 1974. Homemaker S e r v i c e F o r E l d e r l y P e r s o n s i n B.C. C o m m i t t e e on A g i n g , S o c i a l P l a n n i n g , and B r i t i s h Columbia, 4 A p r i l , 1977.  P r e p a r e d by t h e R e v i e w C o u n c i l of  V i s i t i n g Homemaker S e r v i c e s i n C a n a d a : R e p o r t of A S u r v e y Recommendations. P r e p a r e d by t h e A d v i s o r y C o m m i t t e e V i s i t i n g Homemaker S e r v i c e s , The C a n a d i a n C o u n c i l on D e v e l o p m e n t , O t t a w a , M a r c h , 1971.  Primary  and  with on Social  S e c o n d a r y S o u r c e Documents  V a n c o u v e r Sun,  14 February.,  Province  (Vancouver),  Colonist  (Victoria  1973.  5 January,  ), 11 J u n e ,  1978. 1979.  D e v e l o p m e n t o f t h e V a n c o u v e r C i t y C o l l e g e Homemaker P r o g r a m , R e p o r t o f P h a s e I I I , Document p u b l i s h e d by V a n c o u v e r Community C o l l e g e , K i n g E d w a r d Campus, J u n e , 1978. I n t r o d u c t i o n t o t h e P r o g r a m o f L o n g Term C a r e , Document p u b l i s h e d by t h e B r i t i s h C o l u m b i a M i n i s t r y of H e a l t h , January, 1978. M i n u t e s f r o m t h e B o a r d of D i r e c t o r s ' M e e t i n g s , A g e n c y r e s e a r c h e d : 1938; J u n e , 1980; O c t o b e r , 1980; November, 1980. P o s i t i o n P a p e r Homemaker P r o g r a m P e r s o n a l A s s i s t a n c e G u i d e l i n e s P r e p a r e d by t h e A d v i s o r y C o m m i t t e e t o t h e Homemaker P r o g r a m , V a n c o u v e r Community C o l l e g e , K i n g Edward Campus, June, 1980. P e r s o n a l A s s i s t a n c e G u i d e l i n e s o f t h e P r o v i n c i a l A s s o c i a t i o n of Homemaker A g e n c i e s o f B r i t i s h C o l u m b i a , 1979.  81  R e p o r t of t h e E x e c u t i v e D i r e c t o r , Agency r e s e a r c h e d , t o t h e A n n u a l M e e t i n g o f t h e Homemaker A s s o c i a t i o n , S e p t e m b e r , 1980. Undated b r o c h u r e , agency r e s e a r c h e d , c o n c e r n i n g d e s c r i p t i o n of homemaker s e r v i c e s . Undated i n t e r n a l communication, agency r e s e a r c h e d , homemaker t r a i n i n g .  regarding  V a n c o u v e r Community C o l l e g e Homemaker P r o g r a m - A l t e r n a t i v e 1, Document i s s u e d by V a n c o u v e r Community C o l l e g e , 1980.  82  Appendix The content  f o l l o w i n g m a t e r i a l i s p r o v i d e d a s a e x a m p l e o f how t h e a n a l y s i s coding  Included 1981  was p e r f o r m e d on t h e c l i e n t  i s an a c t u a l c l i e n t  client  list.  file  files.  t h a t was c h o s e n f r o m a c u r r e n t  A l l c o n f i d e n t i a l m a t e r i a l and i d e n t i f y i n g  c h a r a c t e r i s t i c s have been removed f o r t h e p u r p o s e o f a s s u r i n g confidentiality  t o the c l i e n t ,  t h e agency, and a l l o t h e r  parties  involved.  Content A n a l y s i s . o f a C l i e n t F i l e  Related to Categories  Researched Within This  Age  : 81 ( h u s b a n d ) 76  (wife).  Sex  : Male and Female  (Couple).  Number i n F a m i l y U n i t Area  of Residence  Thesis  : 2.  : 18.  R e f e r r a l Mode : M e d i c a l  Staff.  C l i e n t Diagnosis Catagory  : Medical  Problems.  Homemaker P r a c t i c e C a t e g o r i e s : C l e a n i n g , L a u n d r y , Meal P r e p a r a t i o n = Combined Housekeeping. P r o v u s E v a l u a t i o n C a t e g o r i e s = 8.0 C l e a n ; and  10.0 P r e p a r e  Meals.  9.0 Do L a u n d r y ,  ENQUIRY FOR HOMEMAKER SERVICE  8 3  </A/ /x  DATE.  /  CLIt..f'S  /jRNAME  *  HUSBAND  BIRTHDAY  .  W'FE  , ^  • H O M E PHONE:*.  BIRTHDAY  . BUS. P H O N E :  1  ADDRESS  Single (  )  CHILDREN:  Married  Sep. (  KiA  NAME  )  Wid. (  )  BIRTH DATE  1  Div. • ' ( " ) SCHOOL  :  :  2  ;  3  :  4  .  :  5  6  Others in the home: _ _  DATE SERVICE  RES/NON-RES.  R E Q U I RE D  CP HOURS O FWORK  DOCTOR  PHONE No.  R E F E R R E D BY: -  <^ 1 '  J  *  DURATION?  SPECIALIST  PHONE No.  '  REASONS FORSERVICE: -  Us-tjj.  _  D A Y S O FWORK  CC^ 0C\i>>^j iA >  )  ( / r j n ^ v w - v -  / K - ^ J -  b'pA^jL  

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